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General NPI Number Information
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NPI Number | 1477340909
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Entity Type | Individual
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Provider Name | OLUMIDE STEPHEN BAMIYO CAA
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Gender | Male
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 865 DESHONG DR
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City | PARIS
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State | TX
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Zip | 75460-9313
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Country | US
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Telephone | 903-737-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 26923 LONGWOOD LEDGE LN
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City | THE WOODLANDS
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State | TX
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Zip | 77389-1924
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Country | US
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Telephone | 912-480-7550
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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