Healthcare Provider Details

I. General information

NPI: 1851710313
Provider Name (Legal Business Name): ABAYOMI EMMANUEL FABUNMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13303 N DALE MABRY HWY
TAMPA FL
33618-2409
US

IV. Provider business mailing address

43309 US HIGHWAY 19 N
TARPON SPRINGS FL
34689-6221
US

V. Phone/Fax

Practice location:
  • Phone: 727-938-2020
  • Fax:
Mailing address:
  • Phone: 727-943-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME141117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: