Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | ME106194 | FL |
Y | 207V00000X | Obstetrician & Gynecologist | ME106194 | FL |
NPI | 1386804334 |
---|---|
Provider Name | Dr. Ezekiel Aderemi Osuntogun |
First Address | Tampa, FL 33646-0105 |
Second Address | Tampa, FL 33613-4657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 15/01/2019 |