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General NPI Number Information
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NPI Number | 1073562419
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Entity Type | Individual
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Provider Name | MOBOLAJI ODELOWO MD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 600 S CONROE MEDICAL DR STE 102
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City | CONROE
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State | TX
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Zip | 77304-5341
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Country | US
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Telephone | 936-539-4031
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Fax | 936-539-4537
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Provider Business Mailing Address
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Address Line | 600 S CONROE MEDICAL DR STE 102
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City | CONROE
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State | TX
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Zip | 77304-5341
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Country | US
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Telephone | 936-539-4031
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Fax | 936-539-4537
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L9832
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | L9832
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | L9832
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License Number State | TX
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