Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | R8447 | TX |
Y | 111NI0900X | Internist | R8447 | TX |
NPI | 1003227745 |
---|---|
Provider Name | Adetomiwa Ogundere |
First Address | Lubbock, TX 79430-0002 |
Second Address | Odessa, TX 79763-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 13/09/2018 |