Individual
DR. OMOLOLA OLADUNNI IDOWU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, SUITE B319, JACKSON, MS 39216-4500
(601) 948-5022
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5017
(601) 984-5042
Taxonomy
Speciality
Code
Description
License number
State
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
Primary
20872
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09053511
—
MS
05
—
1338435
—
LA
01
—
P0787985
RAILROAD MEDICARE
MS
Enumeration date
09/10/2007
Last updated
10/08/2018
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