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1326132804 NPI number — OLATOKUNBO EFUNSAMI SOYODE-ETOMI M.D.

NPI Number: 1326132804
Health Care Provider/Practitioner: OLATOKUNBO EFUNSAMI SOYODE-ETOMI M.D.

Information about “1326132804” NPI (OLATOKUNBO EFUNSAMI SOYODE-ETOMI M.D.) exists in 1326132804 in HTML format HTML  |  1326132804 in plain Text format TXT  |  1326132804 in PDF (Portable Document Format) PDF  |  1326132804 in an XML format XML  formats.

NPI Number : 1326132804 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326132804",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SOYODE-ETOMI",
    "FirstName": "OLATOKUNBO",
    "MiddleName": "EFUNSAMI",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "500 ARCHDALE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28217-4217",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-332-9001",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "549 COX RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GASTONIA",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28054-0628",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-865-1558",
    "PracticeLocationAddressFaxNumber": "704-865-9908",
    "EnumerationDate": "10/02/2006",
    "LastUpdateDate": "10/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": "9300327",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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