Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MB08388000 | NJ |
N | 111NI0900X | Internist | 25MB08388000 | NJ |
N | 207RC0000X | Internist - Cardiovascular Disease | 2572 | TN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 2572 | TN |
NPI | 1205000296 |
---|---|
Provider Name | Dr. Simon Olalekan Okewole |
First Address | Jackson, TN 38305-2862 |
Second Address | Jackson, TN 38305-2862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396033379 | NPI (01) | TN |
2572 | STATE LICENSE (01) | TN |