Provider Demographics
NPI:1902193758
Name:ALAKA, EDMOND OLATUNDE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:OLATUNDE
Last Name:ALAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OLATUNDE
Other - Middle Name:EDMOND
Other - Last Name:ALAKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:216 ELM DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324
Mailing Address - Country:US
Mailing Address - Phone:661-713-7860
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324
Practice Address - Country:US
Practice Address - Phone:850-663-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109501208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice