Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | ME0045179 | FL |
N | 207VG0400X | Gynecologist | ME0045179 | FL |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | ME0045179 | FL |
N | 207VX0000X | Obstetrician | ME0045179 | FL |
NPI | 1275523227 |
---|---|
Provider Name | Dr. Oliver Kenneth Bayouth JR. |
First Address | Orlando, FL 32806-1110 |
Second Address | Orlando, FL 32806-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D84784 | (02) | FL |