Healthcare Provider Details

I. General information

NPI: 1982896742
Provider Name (Legal Business Name): SESAN FATUADE OGUNLEYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 3RD ST SUITE 200
WICHITA FALLS TX
76301-2245
US

IV. Provider business mailing address

5601 CENTRAL FWY APT 3713
WICHITA FALLS TX
76305-6723
US

V. Phone/Fax

Practice location:
  • Phone: 940-767-5145
  • Fax:
Mailing address:
  • Phone: 940-851-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25677
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25677
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: