Provider Demographics
NPI:1245385657
Name:OKUWOBI, OLUKAYODE O (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUKAYODE
Middle Name:O
Last Name:OKUWOBI
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 1:17302 HARVEST HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-8024
Mailing Address - Country:US
Mailing Address - Phone:281-277-5557
Mailing Address - Fax:
Practice Address - Street 1:17302 HARVEST HOLLOW CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-8024
Practice Address - Country:US
Practice Address - Phone:281-277-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG81098Medicare UPIN