Provider Demographics
NPI:1487951059
Name:REMI JAIYEOLA MD PLLC
Entity type:Organization
Organization Name:REMI JAIYEOLA MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REMI
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAIYEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-627-6020
Mailing Address - Street 1:PO BOX 4510
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-4510
Mailing Address - Country:US
Mailing Address - Phone:956-627-6020
Mailing Address - Fax:956-627-6024
Practice Address - Street 1:509 E PIKE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4905
Practice Address - Country:US
Practice Address - Phone:956-627-6020
Practice Address - Fax:956-627-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0476207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283269301Medicaid
TX283269301Medicaid