Healthcare Provider Details

I. General information

NPI: 1588043350
Provider Name (Legal Business Name): HEZEKIAH GEORGE OWOJUYIGBE M.D, M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE OWO M.D, M.P.H.

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 RIVER ST
PALATKA FL
32177-5042
US

IV. Provider business mailing address

1302 RIVER ST
PALATKA FL
32177-5042
US

V. Phone/Fax

Practice location:
  • Phone: 386-328-8371
  • Fax: 386-325-1086
Mailing address:
  • Phone: 386-328-8371
  • Fax: 386-325-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13606I
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19,119
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN 746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: