NPI | 1801892963 |
---|---|
Doing Business As | GLORY MEDICAL CENTER & WEIGHT LOSS CLINIC |
Entity Type | Organization |
Authorized Contact | DAVID OMOTAYO IKUDAYISI President/Owner 813-932-9798 |
Organization Subpart ? | No |
Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME 87841) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 87841) |
Enumeration Date | 2005-06-23 |
Last Update Date | 2007-10-30 |