Healthcare Provider Details

I. General information

NPI: 1053499368
Provider Name (Legal Business Name): JAMES OYETUNDE OYEKAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/04/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR DEPT OB/GYN
JBSA, FORT SAM HOUSTON TX
78253
US

IV. Provider business mailing address

411 EISSMAN RD AT 6
LEESVILLE LA
71446-5430
US

V. Phone/Fax

Practice location:
  • Phone: 210-221-0938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number0101253319
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA07947500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: