Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2014-00579 | NC |
Y | 111NI0900X | Internist | 2014-00579 | NC |
N | 207R00000X | Internist | 4301090347 | MI |
N | 111NI0900X | Internist | 4301090347 | MI |
NPI | 1003006503 |
---|---|
Provider Name | Dr. Olugbemiga Ebenezer Jegede |
First Address | Greensboro, NC 27403-1129 |
Second Address | Greensboro, NC 27401-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2007 |
Last Update Date | 10/11/2021 |