Healthcare Provider Details

I. General information

NPI: 1477872927
Provider Name (Legal Business Name): JANAI MARLIS OKORODUDU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 SINGLETON BLVD
DALLAS TX
75212-4014
US

IV. Provider business mailing address

809 SINGLETON BLVD
DALLAS TX
75212-4014
US

V. Phone/Fax

Practice location:
  • Phone: 214-540-0300
  • Fax: 214-379-2281
Mailing address:
  • Phone: 214-540-0300
  • Fax: 214-379-2281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number164499
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP7173
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: