Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | R75772 | AZ |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 95946 | ZZ |
NPI | 1295289247 |
---|---|
Provider Name | Dr. Olubukunola Ayeni |
First Address | Phoenix, AZ 85006 |
Second Address | Phoenix, AZ 85006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2016 |
Last Update Date | 09/03/2017 |