Provider Demographics
NPI:1851846760
Name:IGBEKOYI, OLUGBEMIGA
Entity Type:Individual
Prefix:MR
First Name:OLUGBEMIGA
Middle Name:
Last Name:IGBEKOYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 QUEENS CT N APT C
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2465
Mailing Address - Country:US
Mailing Address - Phone:682-248-9245
Mailing Address - Fax:
Practice Address - Street 1:320 QUEENS CT N APT C
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2465
Practice Address - Country:US
Practice Address - Phone:682-248-9245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies