Provider Demographics
NPI:1063417715
Name:OLADE, ROGER B (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:B
Last Name:OLADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12155 SHADOW CREEK PKWY STE 114
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7289
Mailing Address - Country:US
Mailing Address - Phone:832-263-7490
Mailing Address - Fax:888-977-1299
Practice Address - Street 1:12155 SHADOW CREEK PKWY STE 114
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7289
Practice Address - Country:US
Practice Address - Phone:832-263-7490
Practice Address - Fax:888-977-1299
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-18
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ32339207R00000X
TXQ2173207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA565632720AMedicaid
GAH85782Medicare UPIN