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General NPI Number Information
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NPI Number | 1518384619
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Entity Type | Individual
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Provider Name | OLUWATOSIN OMOLE M.D, MPH
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Gender | Male
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 903 W MARTIN ST
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City | SAN ANTONIO
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State | TX
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Zip | 78207-0903
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Country | US
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Telephone | 210-358-3441
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Fax | 210-358-5944
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Provider Business Mailing Address
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Address Line | P.O. BOX 87
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City | SAN ANTONIO
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State | TX
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Zip | 78207
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Country | US
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Telephone | 210-358-9172
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Fax | 210-358-9183
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R3169
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License Number State | TX
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