Provider Demographics
NPI:1083624746
Name:KUYE, MOGBOLAHAN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MOGBOLAHAN
Middle Name:MARTIN
Last Name:KUYE
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 1:597 W SESAME DR STE A
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8365
Mailing Address - Country:US
Mailing Address - Phone:956-425-9181
Mailing Address - Fax:956-425-1262
Practice Address - Street 1:597 W SESAME DR STE A
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8365
Practice Address - Country:US
Practice Address - Phone:956-425-9181
Practice Address - Fax:956-425-1262
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183897103Medicaid
TX183897102Medicaid
TX183897102Medicaid
TX183897103Medicaid