Provider Demographics
NPI:1285021857
Name:C FOLASHADE OGUNRO MD PA
Entity Type:Organization
Organization Name:C FOLASHADE OGUNRO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-554-2917
Mailing Address - Street 1:3450 W WHEATLAND RD
Mailing Address - Street 2:POB II SUITE 430
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3470
Mailing Address - Country:US
Mailing Address - Phone:972-296-3875
Mailing Address - Fax:972-296-3575
Practice Address - Street 1:3450 W WHEATLAND RD
Practice Address - Street 2:POB II SUITE 430
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3470
Practice Address - Country:US
Practice Address - Phone:972-296-3875
Practice Address - Fax:972-296-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8169207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty