Provider Demographics
NPI:1134349046
Name:IJEWERE, PATRICK ABHULIME (BPHARM, MD, MBA)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ABHULIME
Last Name:IJEWERE
Suffix:
Gender:M
Credentials:BPHARM, MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-1250
Mailing Address - Country:US
Mailing Address - Phone:813-784-4440
Mailing Address - Fax:813-231-0099
Practice Address - Street 1:7110 N NEBRASKA AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-4954
Practice Address - Country:US
Practice Address - Phone:813-231-0082
Practice Address - Fax:813-231-0099
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 70993OtherSTATE LICENSE NUMBER