Organization
DOCTORS FAMILY PRACTICE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENEDICTA O UDEAGBALA D.O. (MEDICAL DIRECTOR)
(614) 322-6063
Entity
Organization
Contact information
Practice address
6543 E MAIN ST, SUITE C, REYNOLDSBURG, OH 43068-2429
(614) 322-6063
(614) 322-9710
Mailing address
PO BOX 785, REYNOLDSBURG, OH 43068-0785
(614) 322-6063
(614) 322-9710
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
OH6079
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0241812
—
OH
Enumeration date
12/12/2007
Last updated
02/17/2012
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