Provider Demographics
NPI:1730189952
Name:OLATINWO, MOSHOOD (MD)
Entity type:Individual
Prefix:
First Name:MOSHOOD
Middle Name:
Last Name:OLATINWO
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 1:617A BIENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5730
Mailing Address - Country:US
Mailing Address - Phone:318-352-1108
Mailing Address - Fax:318-352-1106
Practice Address - Street 1:617A BIENVILLE ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5730
Practice Address - Country:US
Practice Address - Phone:318-352-1108
Practice Address - Fax:318-352-1106
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203547207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911284Medicaid
MS09001250Medicaid
LA2100882Medicaid
GA000973233Medicaid
AL515542695OtherBCBS - 1720 CENTER ST
AL51542720OtherBCBS - 1610 CENTER ST
AL009911291Medicaid
LA2100882Medicaid
AL009911284Medicaid
AL051559825Medicare PIN
MS09001250Medicaid