Basic Information
| Provider Information | |||||||||
| NPI: | 1568508448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOYINKA | ||||||||
| FirstName: | OLUFEMI | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 629 NUCKOLLS RD | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380081599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316583388 | ||||||||
| FaxNumber: | 7316584079 | ||||||||
| Practice Location | |||||||||
| Address1: | 629 NUCKOLLS RD | ||||||||
| Address2: | |||||||||
| City: | BOLIVAR | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380081599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316583388 | ||||||||
| FaxNumber: | 7316584079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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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 | 207Q00000X | 42451 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00684728 | 01 | TN | RR MEDICARE | OTHER | 4186909 | 01 | TN | BCBS | OTHER | 30004592 | 05 | TN | MEDICAID |