Provider Demographics
NPI:1598090599
Name:IYABODE OGUNLADE, MD PA
Entity Type:Organization
Organization Name:IYABODE OGUNLADE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IYABODE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGUNLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-764-4043
Mailing Address - Street 1:1602 ROCK PRAIRIE RD
Mailing Address - Street 2:STE 3000
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8306
Mailing Address - Country:US
Mailing Address - Phone:979-764-4043
Mailing Address - Fax:979-694-2175
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:STE 3000
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-764-4043
Practice Address - Fax:979-694-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty