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General NPI Number Information
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NPI Number | 1720389265
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Entity Type | Organization
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Legal Business Name | 2FFORDABLE FAMILY CLINIC INC.
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 1927 E BELT LINE RD STE 146
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City | CARROLLTON
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State | TX
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Zip | 75006-5821
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Country | US
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Telephone | 972-820-6660
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Fax | 972-820-6631
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Provider Business Mailing Address
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Address Line | 1927 E BELT LINE RD STE 146
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City | CARROLLTON
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State | TX
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Zip | 75006-5821
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Country | US
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Telephone | 972-820-6660
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Fax | 972-820-6631
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENEDICT O OLUSOLA
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Credential | MD
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Telephone | 972-820-6660
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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 | J7118
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License Number State | TX
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