Provider Demographics
NPI:1891732715
Name:OLOYO, SAMUEL DURO (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DURO
Last Name:OLOYO
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 1:6809 EVERHART RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2453
Mailing Address - Country:US
Mailing Address - Phone:361-854-7001
Mailing Address - Fax:361-855-8444
Practice Address - Street 1:6809 EVERHART RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2453
Practice Address - Country:US
Practice Address - Phone:361-854-7001
Practice Address - Fax:361-855-8444
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159697501Medicaid
TX00505UMedicare ID - Type Unspecified
TX159697501Medicaid