Healthcare Provider Details

I. General information

NPI: 1295422434
Provider Name (Legal Business Name): TEMITOPE ADEGBAYI OLOKUNLADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 FRANCISCAN DR
BRYAN TX
77802-2544
US

IV. Provider business mailing address

2801 FRANCISCAN DR
BRYAN TX
77802-2544
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-5967
  • Fax: 979-731-5619
Mailing address:
  • Phone: 979-776-5967
  • Fax: 979-731-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberW7396
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberW7396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: