Healthcare Provider Details

I. General information

NPI: 1346982477
Provider Name (Legal Business Name): OLAJUMOKE IDAYAT IDRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 ALDINE MAIL ROUTE RD
HOUSTON TX
77039-5934
US

IV. Provider business mailing address

4755 ALDINE MAIL ROUTE RD
HOUSTON TX
77039-5934
US

V. Phone/Fax

Practice location:
  • Phone: 281-985-7600
  • Fax:
Mailing address:
  • Phone: 281-985-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV8650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: