Individual
JADESOLA I OMOYENI
Active
Individual
JADESOLA I OMOYENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
R6776
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
385652801
—
TX
05
—
385652802
—
TX
Enumeration date
08/05/2012
Last updated
10/07/2020
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