Provider Demographics
NPI:1124350442
Name:OLOWOOKERE, AYODELE O (MD)
Entity type:Individual
Prefix:
First Name:AYODELE
Middle Name:O
Last Name:OLOWOOKERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5426
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5400
Mailing Address - Country:US
Mailing Address - Phone:432-686-6600
Mailing Address - Fax:432-682-2284
Practice Address - Street 1:400 ROSALIND REDFERN GROVER PKWY, STE 281
Practice Address - Street 2:CRADDICK MEDICAL OFFICE BUILDING
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5904
Practice Address - Country:US
Practice Address - Phone:432-688-8888
Practice Address - Fax:432-686-8348
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4638207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214656501Medicaid
TX8CG382OtherBCBS
TX214656501Medicaid