Healthcare Provider Details

I. General information

NPI: 1083624746
Provider Name (Legal Business Name): MOGBOLAHAN MARTIN KUYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 W SESAME DR STE A
HARLINGEN TX
78550-8365
US

IV. Provider business mailing address

597 W SESAME DR STE A
HARLINGEN TX
78550-8365
US

V. Phone/Fax

Practice location:
  • Phone: 956-425-9181
  • Fax: 956-425-1262
Mailing address:
  • Phone: 956-425-9181
  • Fax: 956-425-1262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM4255
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: