Provider Demographics
NPI:1740573997
Name:OBAYAN, OLUBUSAYO (MD, MPH)
Entity Type:Individual
Prefix:
First Name:OLUBUSAYO
Middle Name:
Last Name:OBAYAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 MOUNTAIN RIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7303
Mailing Address - Country:US
Mailing Address - Phone:512-312-7552
Mailing Address - Fax:512-714-4786
Practice Address - Street 1:9015 MOUNTAIN RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7303
Practice Address - Country:US
Practice Address - Phone:512-312-7552
Practice Address - Fax:512-714-4786
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02257207R00000X
TXQ5053207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351537102Medicaid
TX351537101Medicaid
TX351537101Medicaid
TX444055YKXVMedicare PIN