MEDICARE: OLUSOLA OLOFINLADE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	L2520	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093750531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUSOLA OLOFINLADE M.D.

Provider Business Mailing Address
First Line	:	701 E MARSHALL AVE
Second Line	:	STE. 200
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5573
Country	:	US
Telephone Number	:	903-236-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E MARSHALL AVE
Second Line	:	STE. 200
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5573
Country	:	US
Telephone Number	:	903-236-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	02/11/2011

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