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NPI Code Detail

MEDICARE: MR. HENRY A ODUKOMAIYA M.D.

MEDICARE: MR. HENRY A ODUKOMAIYA 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
1207Q00000XFamily Medicine PhysicianME68789FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740254184
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HENRY A ODUKOMAIYA M.D.
Provider Business Mailing Address
First Line : PO BOX 47535
Second Line :
City : TAMPA
State : FL
Zip : 33646-0113
Country : US
Telephone Number : 813-755-0006
Fax Number : 813-986-2731
Provider Business Practice Location Address
First Line : 5331 PRIMROSE LAKE CIR STE 112
Second Line :
City : TAMPA
State : FL
Zip : 33647-3764
Country : US
Telephone Number : 813-651-1085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 05/27/2021

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