Individual
DR. OLATUNJI JONATHAN OLUWATADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2080 S, FRONTAGE RD., SUITE100, VICKSBURG, MS 39180-5883
(601) 262-1000
Mailing address
2080 S FRONTAGE RD, SUITE 100, VICKSBURG, MS 39180-5328
(601) 262-1000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
19904
MS
207R00000X
Internal Medicine Physician
4301089363
MI
207RI0200X
Infectious Disease Physician
Primary
19904
MS
208M00000X
Hospitalist Physician
19904
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08108016
—
MS
05
—
1811254
—
LA
Enumeration date
03/16/2007
Last updated
03/13/2024
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