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General NPI Number Information
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NPI Number | 1205808318
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Entity Type | Individual
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Provider Name | OLUFEMI TAIWO OLADELE-AJOSE MD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 2111 E DENMAN AVE
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City | LUFKIN
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State | TX
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Zip | 75901-6243
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Country | US
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Telephone | 936-244-0659
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Fax | 936-899-7243
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Provider Business Mailing Address
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Address Line | 347 COUNTY ROAD 8341
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City | NACOGDOCHES
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State | TX
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Zip | 75964-3304
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Country | US
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Telephone | 319-850-0874
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | N9394
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 32077
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N9394
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License Number State | TX
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