Provider Demographics
NPI:1285660589
Name:OYEFARA, BENJAMIN IYIOLA (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:IYIOLA
Last Name:OYEFARA
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 1:2908 EVANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3724
Mailing Address - Country:US
Mailing Address - Phone:318-398-7100
Mailing Address - Fax:
Practice Address - Street 1:2908 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3724
Practice Address - Country:US
Practice Address - Phone:318-398-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12870R207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548316Medicaid
G09346Medicare UPIN
5E266Medicare ID - Type Unspecified