Healthcare Provider Details

I. General information

NPI: 1699623983
Provider Name (Legal Business Name): ABEFE BABATUNDE ODUNTAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16555 SOUTHWEST FWY
SUGAR LAND TX
77479-2668
US

IV. Provider business mailing address

822 MODESTO DR
ROSHARON TX
77583-1944
US

V. Phone/Fax

Practice location:
  • Phone: 281-274-7958
  • Fax: 281-274-8631
Mailing address:
  • Phone: 281-274-7958
  • Fax: 281-274-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number1229519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: