Healthcare Provider Details

I. General information

NPI: 1508247792
Provider Name (Legal Business Name): OLABISI MOLAKE OGUNRO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
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: 972-296-3575
Mailing address:
  • Phone: 972-296-3875
  • Fax: 972-296-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberR6861
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: