Basic Information
| Provider Information | |||||||||
| NPI: | 1124350442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLOWOOKERE | ||||||||
| FirstName: | AYODELE | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5426 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049155400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326866600 | ||||||||
| FaxNumber: | 4326822284 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 ROSALIND REDFERN GROVER PKWY, STE 281 | ||||||||
| Address2: | CRADDICK MEDICAL OFFICE BUILDING | ||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797015904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326888888 | ||||||||
| FaxNumber: | 4326868348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2010 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N4638 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 214656501 | 05 | TX | MEDICAID | 8CG382 | 01 | TX | BCBS | OTHER |