Individual
OLUFEMI E SOYINKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
629 NUCKOLLS RD, BOLIVAR, TN 38008-1599
(731) 658-3388
(731) 658-4079
Mailing address
629 NUCKOLLS RD, BOLIVAR, TN 38008-1599
(731) 658-3388
(731) 658-4079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42451
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004592
—
TN
01
—
4186909
BCBS
TN
01
—
P00684728
RR MEDICARE
TN
Enumeration date
01/29/2007
Last updated
09/29/2011
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