Provider Demographics
NPI:1891825287
Name:FAMUYIDE, MOBOLAJI ENIOLA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MOBOLAJI
Middle Name:ENIOLA
Last Name:FAMUYIDE
Suffix:
Gender:F
Credentials:MD, MPH
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Other - Last Name:
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Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DIVISION OF NEWBORN MEDICINE, UNIV OF MS MEDICAL CENTER
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5260
Mailing Address - Fax:601-815-3666
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DIVISION OF NEWBORN MEDICINE, UNIV OF MS MEDICAL CENTER
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5260
Practice Address - Fax:601-815-3666
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS202372080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I377689Medicare PIN
MS512I370124Medicare PIN