Provider Demographics
NPI:1801122395
Name:OKOYE, GODWIN STANLEY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GODWIN
Middle Name:STANLEY
Last Name:OKOYE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:G. STANLEY
Other - Middle Name:
Other - Last Name:OKOYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:4810 PORTOBELLO CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7372
Mailing Address - Country:US
Mailing Address - Phone:813-498-7019
Mailing Address - Fax:
Practice Address - Street 1:10224 E ADAMO DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-2663
Practice Address - Country:US
Practice Address - Phone:813-315-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107980208U00000X, 208D00000X, 207QA0401X, 207W00000X
PAMD435450146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine