Healthcare Provider Details

I. General information

NPI: 1720327281
Provider Name (Legal Business Name): OLUWATOSIN A OGUNLANA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5209
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-5302
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-2222
  • Fax:
Mailing address:
  • Phone: 409-747-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2063
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: