Provider Demographics
NPI:1336453927
Name:AGU, AJUMOBI CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:AJUMOBI
Middle Name:CHARLES
Last Name:AGU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AJUMOBI
Other - Middle Name:CHARLES
Other - Last Name:AGU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2235 E FLAMINGO RD STE 128
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5189
Mailing Address - Country:US
Mailing Address - Phone:725-204-5658
Mailing Address - Fax:725-204-9077
Practice Address - Street 1:2235 E FLAMINGO RD STE 128
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5189
Practice Address - Country:US
Practice Address - Phone:725-204-5658
Practice Address - Fax:725-204-9077
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine