MEDICARE: AYODEJI AIYEJORUN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	TRN17197	FL

General Provider Information

NPI Number	:	1619236445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYODEJI AIYEJORUN M.D.

Provider Business Mailing Address
First Line	:	1329 SW 16TH ST
Second Line	:	ROOM 4270
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1128
Country	:	US
Telephone Number	:	352-265-5911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 SW ARCHER RD
Second Line	:	EMERGENCY DEPARTMENT
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1134
Country	:	US
Telephone Number	:	352-275-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	05/14/2012

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