Provider Demographics
NPI:1821347279
Name:OGUNDADEGBE, OLUBUNMI
Entity Type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:OGUNDADEGBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18980 N MEMORIAL DR STE 240
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4216
Mailing Address - Country:US
Mailing Address - Phone:713-904-3455
Mailing Address - Fax:281-446-0997
Practice Address - Street 1:18980 N MEMORIAL DR
Practice Address - Street 2:STE 240
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4216
Practice Address - Country:US
Practice Address - Phone:713-904-3455
Practice Address - Fax:713-800-5711
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1481207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics