Provider Demographics
NPI:1679926687
Name:ESOMONU, OBIOMA ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:OBIOMA
Middle Name:ANTHONY
Last Name:ESOMONU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:386-325-1086
Practice Address - Street 1:1028 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4830
Practice Address - Country:US
Practice Address - Phone:047-667-6069
Practice Address - Fax:904-766-7679
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19415208D00000X
FLACN907208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020486500Medicaid