Provider Demographics
NPI:1528196227
Name:OKUBOYE, DEJI O (DO)
Entity Type:Individual
Prefix:
First Name:DEJI
Middle Name:O
Last Name:OKUBOYE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 890273
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0273
Mailing Address - Country:US
Mailing Address - Phone:828-632-7076
Mailing Address - Fax:828-632-7028
Practice Address - Street 1:50 MACEDONIA CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-8414
Practice Address - Country:US
Practice Address - Phone:828-632-7076
Practice Address - Fax:828-632-7028
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9863207Q00000X
NC2008-00736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1501FOtherBCBS OF NC
NC5910493Medicaid
NC2401666Medicare Oscar/Certification