Provider Demographics
NPI:1003006503
Name:JEGEDE, OLUGBEMIGA EBENEZER (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUGBEMIGA
Middle Name:EBENEZER
Last Name:JEGEDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 N ELAM AVE # 3E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1129
Mailing Address - Country:US
Mailing Address - Phone:810-908-9996
Mailing Address - Fax:
Practice Address - Street 1:201 E WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1205
Practice Address - Country:US
Practice Address - Phone:336-832-4444
Practice Address - Fax:336-832-4445
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00579207R00000X
MI4301090347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine