Healthcare Provider Details

I. General information

NPI: 1932235660
Provider Name (Legal Business Name): BABAJIDE A. OGUNSEINDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E HAWKINS PKWY STE A
LONGVIEW TX
75605-7905
US

IV. Provider business mailing address

323 E HAWKINS PKWY STE A
LONGVIEW TX
75605-7905
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-2746
  • Fax: 903-758-7127
Mailing address:
  • Phone: 903-758-2746
  • Fax: 903-758-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberN6546
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: