Healthcare Provider Details

I. General information

NPI: 1528697653
Provider Name (Legal Business Name): OLUWATOBI OHIOLE OZOYA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOBI OZOYA MD, MPH

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MCMILLAN RD NULL
SHREVEPORT LA
71105
US

IV. Provider business mailing address

1000 E PRESTON AVE
SHREVEPORT LA
71105-2704
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-8830
  • Fax: 318-383-2332
Mailing address:
  • Phone: 318-841-9532
  • Fax: 318-841-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number346135
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number346135
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: