Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD449227 | PA |
N | 111NI0900X | Internist | MD449227 | PA |
N | 207R00000X | Internist | ME141781 | FL |
N | 111NI0900X | Internist | ME141781 | FL |
N | 207R00000X | Internist | MT196670 | PA |
N | 111NI0900X | Internist | MT196670 | PA |
N | 207RH0000X | Hematologist | ME141781 | FL |
N | 207RH0003X | Hematology & Oncology | ME141781 | FL |
Y | 207RX0202X | Medical Oncology | ME141781 | FL |
NPI | 1184937518 |
---|---|
Provider Name | Adetokunbo Oluwasanjo |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Lake City, FL 32025-0453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2010 |
Last Update Date | 24/12/2020 |