Healthcare Provider Details

I. General information

NPI: 1659260206
Provider Name (Legal Business Name): OLUEBUBE ALPHONSUS OKOYE MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

110 GISELLE DR
LITTLE ROCK AR
72204-5087
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-5115
  • Fax:
Mailing address:
  • Phone: 501-502-3841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: