Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | R6776 | TX |
NPI | 1043567423 |
---|---|
Provider Name | Jadesola I Omoyeni |
First Address | San Antonio, TX 78217-5211 |
Second Address | San Antonio, TX 78217-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2012 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
385652801 | (05) | TX |
385652802 | (05) | TX |