Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME58278 | FL |
N | 2080P0203X | Pediatric Critical Care Doctor | ME0058278 | FL |
NPI | 1043366131 |
---|---|
Provider Name | Dr. Ayodeji B Otegbeye |
First Address | Orlando, FL 32839-3716 |
Second Address | Orlando, FL 32839-3716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063905200 | (05) | FL |
S27102 | (02) | FL |