Provider Demographics
NPI:1386742849
Name:REIS, OLOLADE A (MD)
Entity type:Individual
Prefix:
First Name:OLOLADE
Middle Name:A
Last Name:REIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4498
Mailing Address - Country:US
Mailing Address - Phone:281-342-4530
Mailing Address - Fax:281-633-3100
Practice Address - Street 1:400 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:281-342-4530
Practice Address - Fax:281-633-3100
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21285OtherMEDICARE PTAN
TX8U3445OtherBCBS OF TEXAS
TX174974904Medicaid
TXP00300720OtherRAILROAD MEDICARE
TX8U3445OtherBCBS OF TEXAS