Individual
DR. IKPONMWOSA IYAMU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
P5821
TX
2085R0204X
Vascular & Interventional Radiology Physician
Primary
P5821
TX
Other
Enumeration date
05/11/2010
Last updated
12/18/2023
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