Provider Demographics
NPI:1568205417
Name:OYEROGBA, TUNDE BENARD
Entity type:Individual
Prefix:
First Name:TUNDE
Middle Name:BENARD
Last Name:OYEROGBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3822 LANDMARK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1620
Mailing Address - Country:US
Mailing Address - Phone:832-230-9522
Mailing Address - Fax:
Practice Address - Street 1:3822 LANDMARK DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1620
Practice Address - Country:US
Practice Address - Phone:832-230-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)