Provider Demographics
NPI:1548260508
Name:OUDERKIRK, JOHN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:OUDERKIRK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:735 PIEDMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1416
Practice Address - Country:US
Practice Address - Phone:404-588-4680
Practice Address - Fax:404-588-4692
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-07-27
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Provider Licenses
StateLicense IDTaxonomies
GA049992207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA453538OtherCHAMPUS
GA7439283OtherUS HEALTH
GA8625897001OtherCIGNA HMO
GA440003559OtherRAILROAD MEDICARE
GA000926318AMedicaid
GA2647814OtherAETNA HMO
GA7439283OtherAETNA
GAH44284Medicare UPIN
GA44ZCBHZMedicare PIN