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NPI Code Detail

MEDICARE: OLUBUKOLA TOKUNBO AMUDIPE M.D.

MEDICARE: OLUBUKOLA TOKUNBO AMUDIPE 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
1207Q00000XFamily Medicine PhysicianD65267MD
2207Q00000XFamily Medicine PhysicianQ8005TX

Other Identifiers

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

General Provider Information

NPI Number : 1346366333
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLUBUKOLA TOKUNBO AMUDIPE M.D.
Provider Business Mailing Address
First Line : 5701 BRYANT IRVIN RD STE 201
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4026
Country : US
Telephone Number : 817-263-2500
Fax Number : 817-346-4006
Provider Business Practice Location Address
First Line : 5701 BRYANT IRVIN RD STE 201
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4026
Country : US
Telephone Number : 817-263-2500
Fax Number : 817-346-4006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/21/2022

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