Provider Demographics
NPI:1255738068
Name:FEMI LAYIWOLA, MD, PA
Entity type:Organization
Organization Name:FEMI LAYIWOLA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYIWOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-465-0626
Mailing Address - Street 1:PO BOX 530654
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-0654
Mailing Address - Country:US
Mailing Address - Phone:956-465-0626
Mailing Address - Fax:877-346-1789
Practice Address - Street 1:4002 PAREDES LINE RD STE 26
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1375
Practice Address - Country:US
Practice Address - Phone:956-465-0626
Practice Address - Fax:877-346-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX379776Medicare Oscar/Certification