Provider Demographics
NPI:1164455598
Name:OLAGUNDOYE, OLASUPO ABIGAIL (MD)
Entity Type:Individual
Prefix:
First Name:OLASUPO
Middle Name:ABIGAIL
Last Name:OLAGUNDOYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 SCHERTZ PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1639
Mailing Address - Country:US
Mailing Address - Phone:210-491-8179
Mailing Address - Fax:210-590-2664
Practice Address - Street 1:1739 SCHERTZ PKWY
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1639
Practice Address - Country:US
Practice Address - Phone:210-491-8179
Practice Address - Fax:210-590-2664
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88Y342OtherBCBS
TX129674107Medicaid
TX129674102Medicaid
TX88Y342Medicare PIN
TX080154176Medicare PIN