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General NPI Number Information
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NPI Number | 1043231228
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Entity Type | Individual
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Provider Name | THEOPHILUS TOLULOPE OGUNGBAMIGBE MD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 1302 BANKSTON LN
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City | MANSFIELD
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State | TX
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Zip | 76063-8676
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Country | US
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Telephone | 785-354-9591
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 BANKSTON LN
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City | MANSFIELD
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State | TX
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Zip | 76063-8676
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Country | US
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Telephone | 917-517-4069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 04-32614
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 04-32614
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 04-32614
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | Q0140
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License Number State | TX
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