MEDICARE: OLUBUNMI OGUNDADEGBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	P1481	TX
2	208000000X	Pediatrics Physician	P1481	TX

General Provider Information

NPI Number	:	1821347279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUBUNMI OGUNDADEGBE

Provider Business Mailing Address
First Line	:	18980 N MEMORIAL DR STE 240
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4216
Country	:	US
Telephone Number	:	713-904-3455
Fax Number	:	281-446-0997

Provider Business Practice Location Address
First Line	:	18980 N MEMORIAL DR
Second Line	:	STE 240
City	:	HUMBLE
State	:	TX
Zip	:	77338-4216
Country	:	US
Telephone Number	:	713-904-3455
Fax Number	:	713-800-5711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	02/20/2020

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Directions to “ OLUBUNMI OGUNDADEGBE ” Practice Location

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