Provider Demographics
NPI:1144578733
Name:OMOOLAYE-ONOVIRAN, OLUSOLA FRANCISCA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSOLA
Middle Name:FRANCISCA
Last Name:OMOOLAYE-ONOVIRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLUSOLA
Other - Middle Name:FRANCISCA
Other - Last Name:OMOOLAYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0567
Mailing Address - Country:US
Mailing Address - Phone:832-505-2100
Mailing Address - Fax:281-337-0704
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0567
Practice Address - Country:US
Practice Address - Phone:832-505-2100
Practice Address - Fax:281-337-0704
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10052132207RG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program