Healthcare Provider Details

I. General information

NPI: 1689963183
Provider Name (Legal Business Name): LATEEF OPABOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0254
US

IV. Provider business mailing address

1600 SW ARCHER RD PO BOX 100254
GAINESVILLE FL
32610-0254
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0077
  • Fax: 352-265-6922
Mailing address:
  • Phone: 352-265-0077
  • Fax: 352-265-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME122900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: