Healthcare Provider Details

I. General information

NPI: 1104309541
Provider Name (Legal Business Name): OLABISI OGUNRO DO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 W WHEATLAND RD
DALLAS TX
75237
US

IV. Provider business mailing address

3670 W WHEATLAND RD
DALLAS TX
75237
US

V. Phone/Fax

Practice location:
  • Phone: 972-296-3875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: OLABISI OGUNRO
Title or Position: OWNER
Credential: DO
Phone: 972-296-3875