Healthcare Provider Details

I. General information

NPI: 1699476432
Provider Name (Legal Business Name): SAMUEL AJAMU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32608-2827
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 352-265-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberTRN40913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: