Provider Demographics
NPI:1649208315
Name:ASHAYE, OLUROTIMI A (MD)
Entity Type:Individual
Prefix:
First Name:OLUROTIMI
Middle Name:A
Last Name:ASHAYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 E GALA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7692
Mailing Address - Country:US
Mailing Address - Phone:208-288-2280
Mailing Address - Fax:208-288-1544
Practice Address - Street 1:2321 E GALA ST STE 3
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7692
Practice Address - Country:US
Practice Address - Phone:208-288-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM86392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry