David Ikudayisi, MD, PA

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

ME 87841 Issued in FL

Legal business name

DAVID IKUDAYISI, MD, PA

Practice address

3651B W Waters Ave
Tampa, FL 33614-2783

Phone

(813) 932-9798

Fax

(813) 935-5178

NPI assigned

Jun 23, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Omotayo Ikudayisi, MDNPI 1164604526

Title

President/Owner

Phone

(813) 932-9798

Specialties & licenses 2

Addresses

Other names 1

• Glory Medical Center & Weight Loss Clinic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David O Ikudayisi, M.D.

  • Pain Medicine Physician
  • New Port Richey, FL
  • NPI 1164604526

  Single Specialty

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1801892963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 272450",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336882450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3651B W WATERS AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336142783",
            "telephone_number": "813-932-9798",
            "fax_number": "813-935-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID IKUDAYISI, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "IKUDAYISI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "OMOTAYO",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "813-932-9798",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 87841",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME 87841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glory Medical Center & Weight Loss Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Caring Home Corp
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• David G. Helsing,OD,PA
• David Goguen Counseling, LLC
• David J Samuels MD PA
• David L Joseph MD PA
• David Mark Monbeck
• David P. Myers, M.D., P.a.
• David R Heiman M D P a

• Geriatric Medicine (Internal Medicine) Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Geriatric Medicine (Internal Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.