Provider Demographics
NPI:1902427156
Name:MORAKINYO, EMMANUEL IYANULOLUWA (MD)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:IYANULOLUWA
Last Name:MORAKINYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 DEER VIEW AVENUE
Mailing Address - Street 2:2001 KINGSLEY AVE
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-639-2000
Mailing Address - Fax:
Practice Address - Street 1:1 SHIRCLIFF WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4748
Practice Address - Country:US
Practice Address - Phone:904-450-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2023-07-14
Deactivation Date:2022-01-10
Deactivation Code:
Reactivation Date:2022-02-19
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLME160765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program