Provider Demographics
NPI:1366679573
Name:OGUNLADE, IYABODE MUNIRAT (MD)
Entity Type:Individual
Prefix:DR
First Name:IYABODE
Middle Name:MUNIRAT
Last Name:OGUNLADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IYABODE
Other - Middle Name:MUNIRAT
Other - Last Name:AGBOOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13523 HARGRAVE ROAD
Mailing Address - Street 2:PRISTINE OB-GYN CARE
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:281-206-4496
Mailing Address - Fax:281-206-4487
Practice Address - Street 1:13523 HARGRAVE ROAD
Practice Address - Street 2:PRISTINE OB-GYN CARE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-206-4496
Practice Address - Fax:281-206-4487
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8471207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207569903Medicaid
TXTXB151866Medicare PIN
TX207569903Medicaid