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1376752048 NPI number — BABATUNDE O. KOMOLAFE MD

NPI Number: 1376752048
Health Care Provider/Practitioner: BABATUNDE O. KOMOLAFE MD

Information about “1376752048” NPI (BABATUNDE O. KOMOLAFE MD) exists in 1376752048 in HTML format HTML  |  1376752048 in plain Text format TXT  |  1376752048 in PDF (Portable Document Format) PDF  |  1376752048 in an XML format XML  formats.

NPI Number : 1376752048 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376752048",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KOMOLAFE",
    "FirstName": "BABATUNDE",
    "MiddleName": "O.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2800 E BROAD ST STE 204",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANSFIELD",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76063-6411",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-752-5242",
    "MailingAddressFaxNumber": "817-752-5232",
    "FirstLinePracticeLocationAddress": "2800 E BROAD ST STE 204",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANSFIELD",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76063-6411",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-752-5242",
    "PracticeLocationAddressFaxNumber": "817-752-5232",
    "EnumerationDate": "05/21/2007",
    "LastUpdateDate": "01/24/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "LicenseNumber": "33580",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RI0011X",
          "TaxonomyName": "Interventional Cardiology Physician",
          "LicenseNumber": "Q0486",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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