Provider Demographics
NPI:1922041193
Name:DESTINY MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:DESTINY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:AZIEGBEMI
Authorized Official - Last Name:OIBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-622-4888
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-0036
Mailing Address - Country:US
Mailing Address - Phone:352-622-4888
Mailing Address - Fax:352-694-4884
Practice Address - Street 1:150 SE 17TH ST
Practice Address - Street 2:SUITE 801
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5178
Practice Address - Country:US
Practice Address - Phone:352-622-4888
Practice Address - Fax:352-694-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty