Provider Demographics
NPI:1568772424
Name:MOGBOLAHAN MARTIN KUYE MD.,PA
Entity Type:Organization
Organization Name:MOGBOLAHAN MARTIN KUYE MD.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOGBOLAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-425-9181
Mailing Address - Street 1:2401 N ED CAREY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 N ED CAREY DR
Practice Address - Street 2:SUITE A
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8205
Practice Address - Country:US
Practice Address - Phone:956-425-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281084801Medicaid
TX281084801Medicaid