Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | LL16650 | OR |
NPI | 1033317367 |
---|---|
Provider Name | Olugbenga Omotayo Sulaiman |
First Address | Eugene, OR 97401-8122 |
Second Address | Eugene, OR 97401-8122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2007 |
Last Update Date | 09/07/2007 |