Organization
DAVID IKUDAYISI, MD, PA
Active
Other names
Glory Medical Center & Weight Loss Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID OMOTAYO IKUDAYISI MD (PRESIDENT/OWNER)
(813) 932-9798
Entity
Organization
Contact information
Practice address
3651B W WATERS AVE, TAMPA, FL 33614-2783
(813) 932-9798
(813) 935-5178
Mailing address
PO BOX 272450, TAMPA, FL 33688-2450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME 87841
FL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME 87841
FL
Other
Enumeration date
06/23/2005
Last updated
10/30/2007
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