Healthcare Provider Details

I. General information

NPI: 1912228800
Provider Name (Legal Business Name): OLUBUNMI TEMITOPE OGUNLEYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 WAGNER ST
HOUSTON TX
77007-3719
US

IV. Provider business mailing address

1234 WAGNER ST
HOUSTON TX
77007-3719
US

V. Phone/Fax

Practice location:
  • Phone: 713-868-3301
  • Fax: 713-868-4817
Mailing address:
  • Phone: 713-868-3301
  • Fax: 713-868-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberN6545
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: