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General NPI Number Information
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NPI Number | 1255666335
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Entity Type | Individual
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Provider Name | JOANN MODUPE BOLUDE M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1315 JEFFERSON HWY
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City | NEW ORLEANS
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State | LA
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Zip | 70121-2406
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Country | US
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Telephone | 504-703-0832
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Fax | 504-736-4623
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Provider Business Mailing Address
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Address Line | 105 S. STEWART
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City | COTULLA
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State | TX
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Zip | 78014-1013
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Country | US
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Telephone | 830-879-3047
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Fax | 210-277-6387
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | Q5763
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | Q5763
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 348591
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License Number State | LA
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