Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 200101258 | NC |
NPI | 1164416806 |
---|---|
Provider Name | Dr. Abayomi W. Osunkoya |
First Address | Boston, MA 02298-6513 |
Second Address | Jacksonville, NC 28546-3219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 17/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
891298C | (05) | NC |
G45378 | (02) | NC |