Provider Demographics
NPI:1629367602
Name:OGIDAN, PATRICK TOLUWATELE (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:TOLUWATELE
Last Name:OGIDAN
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 1:9201 PINECROFT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3889
Mailing Address - Country:US
Mailing Address - Phone:281-863-9554
Mailing Address - Fax:281-651-4818
Practice Address - Street 1:9201 PINECROFT DR STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3889
Practice Address - Country:US
Practice Address - Phone:281-863-9554
Practice Address - Fax:832-813-8865
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9927207R00000X
NY271254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339993301Medicaid
TX374942YL0GMedicare PIN
TX339993301Medicaid