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General NPI Number Information
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NPI Number | 1598090599
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Entity Type | Organization
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Legal Business Name | IYABODE OGUNLADE, MD PA
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 1602 ROCK PRAIRIE RD STE 3000
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8306
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Country | US
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Telephone | 979-764-4043
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Fax | 979-694-2175
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Provider Business Mailing Address
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Address Line | 1602 ROCK PRAIRIE RD STE 3000
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8306
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Country | US
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Telephone | 979-764-4043
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Fax | 979-694-2175
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. IYABODE A OGUNLADE
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Credential | MD
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Telephone | 979-764-4043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M8471
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License Number State | TX
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