Healthcare Provider Details

I. General information

NPI: 1780813444
Provider Name (Legal Business Name): OLUWASEYE ALABI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD BLDG 180
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

600 KENSINGTON DR APT 613
JACKSONVILLE NC
28546-7157
US

V. Phone/Fax

Practice location:
  • Phone: 910-449-1100
  • Fax: 910-450-6831
Mailing address:
  • Phone: 443-852-2730
  • Fax: 888-312-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS 12385
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-02371
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: