Provider Demographics
NPI:1437680915
Name:OGBEIDE, MATTHEW TAIWO ABIOLA (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TAIWO ABIOLA
Last Name:OGBEIDE
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 1:837 LAPWING RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4822
Mailing Address - Country:US
Mailing Address - Phone:405-916-6366
Mailing Address - Fax:
Practice Address - Street 1:10621 CHURCH ST STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6834
Practice Address - Country:US
Practice Address - Phone:909-944-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-25
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA162281208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program