Healthcare Provider Details

I. General information

NPI: 1740573997
Provider Name (Legal Business Name): OLUBUSAYO OBAYAN M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 MOUNTAIN RIDGE DR STE 200
AUSTIN TX
78759-7303
US

IV. Provider business mailing address

9015 MOUNTAIN RIDGE DR STE 200
AUSTIN TX
78759-7303
US

V. Phone/Fax

Practice location:
  • Phone: 512-312-7552
  • Fax: 512-714-4786
Mailing address:
  • Phone: 512-312-7552
  • Fax: 512-714-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP02257
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberQ5053
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: