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Organization
VINE FAMILY MEDICINE PLLC
Active
Organization
VINE FAMILY MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OCHUELE ODUMOSU MD (MEDICAL DIRECTOR)
(817) 710-3040
Entity
Organization
Contact information
Practice address
420 JOHNSON RD STE 304, KELLER, TX 76248-3463
(817) 710-3040
(989) 200-4650
Mailing address
420 JOHNSON RD STE 304, KELLER, TX 76248-3463
(817) 710-3040
(989) 200-4650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/09/2021
Last updated
07/12/2021
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