Healthcare Provider Details

I. General information

NPI: 1972610905
Provider Name (Legal Business Name): BABATUNDE OLADIRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E REED ST
HAYTI MO
63851-1242
US

IV. Provider business mailing address

907 E REED ST P O BOX 489
HAYTI MO
63851-1242
US

V. Phone/Fax

Practice location:
  • Phone: 573-359-3660
  • Fax: 573-359-3521
Mailing address:
  • Phone: 573-359-3660
  • Fax: 573-359-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35613
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-12122
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-12122
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: