Individual
DR. ANTHONY ADEN OMBOGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3911 S NOVA RD, PORT ORANGE, FL 32127-4910
(386) 756-7748
(386) 761-5449
Mailing address
303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 756-7748
(386) 761-5449
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
66728
GA
207Q00000X
Family Medicine Physician
Primary
ME108702
FL
207Q00000X
Family Medicine Physician
TRN12964
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112054A
—
GA
Enumeration date
09/30/2010
Last updated
06/11/2021
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