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Individual

DR. OLUMUYIWA GISANRIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
120 MONTICELLO AVE, WILLIAMSBURG, VA 23185-2840
(757) 564-3627
(757) 564-6449
Mailing address
PO BOX 5508, VIRGINIA BEACH, VA 23471-0508
(757) 340-3489
(757) 340-4278

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101238858
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0101238858
STATE LICENCE
VA
Enumeration date
10/04/2006
Last updated
03/27/2013
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