Healthcare Provider Details

I. General information

NPI: 1609225341
Provider Name (Legal Business Name): BUKOLA ESHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 11TH ST UNIT B
WICHITA FALLS TX
76301-4332
US

IV. Provider business mailing address

1631 11TH ST UNIT B
WICHITA FALLS TX
76301-4332
US

V. Phone/Fax

Practice location:
  • Phone: 469-257-3500
  • Fax: 940-263-3018
Mailing address:
  • Phone: 469-257-3500
  • Fax: 940-263-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS0282
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number268214
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: