Individual
DR. OSAYANDE STEPHEN IZEIYAMU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
194 SW WALL TER, LAKE CITY, FL 32025-5086
(386) 719-9227
(386) 719-9488
Mailing address
194 SW WALL TER, LAKE CITY, FL 32025-5086
(386) 719-9227
(386) 719-9488
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
BP10043366
TX
208D00000X
General Practice Physician
Primary
ACN634
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014632400
—
FL
Enumeration date
04/23/2012
Last updated
01/20/2016
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