Basic Information
| Provider Information | |||||||||
| NPI: | 1407437361 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ODUMOSU | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | OLUWASEYI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 716 SLEEPY CREEK DR | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277139132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523279662 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 MANNING DR # 7600 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665136 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2021 | ||||||||
| LastUpdateDate: | 10/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | RTL21-0275 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 2022-02629 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.