Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 039240 | GA |
Y | 207YS0123X | Facial Plastic Surgeon | N0472 | TX |
NPI | 1578621256 |
---|---|
Provider Name | Dr. Ifeolumipo O Sofola |
First Address | The Woodlands, TX 77380-3179 |
Second Address | The Woodlands, TX 77380-3179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 26/08/2015 |