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General NPI Number Information
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NPI Number | 1104005297
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Entity Type | Organization
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Legal Business Name | EMMANUEL O. SOYOOLA MD PC
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 70 HOSPITAL DR KRUGER MEDICAL PLAZA, SUITE 200
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City | LOGAN
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State | WV
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Zip | 25601-3452
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Country | US
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Telephone | 304-752-6780
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Fax | 304-752-6782
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Provider Business Mailing Address
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Address Line | PO BOX 536
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City | LOGAN
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State | WV
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Zip | 25601-0536
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Country | US
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Telephone | 304-752-6780
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Fax | 304-752-6782
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. EMMANUEL OLUSOLA SOYOOLA
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Credential | M.D.,PHD.,F.A.C.O.G.
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Telephone | 304-752-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 21399
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License Number State | WV
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