Provider Demographics
NPI:1326508433
Name:OKPOKPO, ENOEMEM (DO)
Entity Type:Individual
Prefix:
First Name:ENOEMEM
Middle Name:
Last Name:OKPOKPO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12123 RUSTIC RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9536
Mailing Address - Country:US
Mailing Address - Phone:954-305-6374
Mailing Address - Fax:
Practice Address - Street 1:12123 RUSTIC RIVER WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9536
Practice Address - Country:US
Practice Address - Phone:954-305-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS17819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program