Provider Demographics
NPI:1215192828
Name:DANIELS, OLUSESAN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSESAN
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OLUSESAN
Other - Middle Name:
Other - Last Name:OGUNTUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 S BONHAM ST
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-3603
Mailing Address - Country:US
Mailing Address - Phone:903-722-3138
Mailing Address - Fax:
Practice Address - Street 1:608 EASTON LN
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5818
Practice Address - Country:US
Practice Address - Phone:903-722-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192792207Q00000X
TXP1204207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine