Individual
DR. OMOTAYO MUTIAT OLATINWO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
ALEXANDRIA VA HEALTH CARE SYSTEM, 2495 SHREVEPORT HIGHWAY, PINEVILLE, LA 71360
(318) 473-0010
Mailing address
ALEXANDRIA VA HEALTH CARE SYSTEM, 2495 SHREVEPORT HIGHWAY, PINEVILLE, LA 71360-4044
(318) 473-0010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD.204261
LA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
063279
GA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD.204261
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2160818
—
LA
Enumeration date
04/10/2008
Last updated
09/13/2023
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