Individual
DR. OMOFOLARIN BABATUNJI FASUYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D, M.P.H
Contact information
Practice address
1605 MARTIN SPRINGS DR, SUITE 210, ROLLA, MO 65401-2982
(573) 458-6326
Mailing address
1605 MARTIN SPRINGS DR, SUITE 210, ROLLA, MO 65401-2982
(573) 458-6326
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2016023338
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104260090
—
MO
Enumeration date
04/22/2013
Last updated
07/21/2022
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