Basic Information
| Provider Information | |||||||||
| NPI: | 1619206224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IBIDAPO-OBE | ||||||||
| FirstName: | OYETOKUNBO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775551385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097722166 | ||||||||
| FaxNumber: | 4097722663 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775551385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097722166 | ||||||||
| FaxNumber: | 4097722663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2009 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14777 | ND | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | P7786 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.