Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | AP139389 | TX |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP139389 | TX |
NPI | 1235605064 |
---|---|
Provider Name | Bola Olasunkanmi Jaiyeola |
First Address | Katy, TX 77493-2683 |
Second Address | Midland, TX 79701-6499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2018 |
Last Update Date | 11/01/2021 |