Provider Demographics
NPI:1588911390
Name:MAGNUS-LAWSON, OLUWABOMILASIRI (MD)
Entity type:Individual
Prefix:DR
First Name:OLUWABOMILASIRI
Middle Name:
Last Name:MAGNUS-LAWSON
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 1:1315 ST JOSEPH PKWY STE 1704
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8238
Mailing Address - Country:US
Mailing Address - Phone:832-216-1424
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1704
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8238
Practice Address - Country:US
Practice Address - Phone:832-216-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.208138207RN0300X
TXS2832207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program