Organization
GENPROV LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER OLADE MD (OWNER)
(404) 441-8752
Entity
Organization
Contact information
Practice address
2301 HARBOR CHASE DRIVE, PEARLAND, TX 77584
(404) 441-8752
Mailing address
2301 HARBOR CHASE DR, PEARLAND, TX 77584-3423
(404) 441-8752
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
Q2173
TX
207R00000X
Internal Medicine Physician
Q2173
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q2173
TEXAS MEDICAL BOARD
TX
Enumeration date
04/19/2018
Last updated
04/19/2018
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