Basic Information
Provider Information
NPI: 1891350500
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BABALOLA ODEYOMI
FirstName: SARAH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1400 N-IH 35
Address2: STE C2.410
City: AUSTIN
State: TX
PostalCode: 78701
CountryCode: US
TelephoneNumber: 5123247318
FaxNumber:  
Practice Location
Address1: 1400 N-IH 35
Address2: STE C2.410
City: AUSTIN
State: TX
PostalCode: 78701
CountryCode: US
TelephoneNumber: 5123247318
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/08/2019
LastUpdateDate: 08/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XBP10066939TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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