Healthcare Provider Details

I. General information

NPI: 1124350442
Provider Name (Legal Business Name): AYODELE O OLOWOOKERE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ROSALIND REDFERN GROVER PKWY, STE 281 CRADDICK MEDICAL OFFICE BUILDING
MIDLAND TX
79701-5904
US

IV. Provider business mailing address

PO BOX 5426
BELFAST ME
04915-5400
US

V. Phone/Fax

Practice location:
  • Phone: 432-688-8888
  • Fax: 432-686-8348
Mailing address:
  • Phone: 432-686-6600
  • Fax: 432-682-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN4638
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: