Provider Demographics
NPI:1326292988
Name:DAVID O. OPAWUMI MD. PA
Entity Type:Organization
Organization Name:DAVID O. OPAWUMI MD. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:OLUWOLE
Authorized Official - Last Name:OPAWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-595-2286
Mailing Address - Street 1:10201 GATEWAY WEST BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7652
Mailing Address - Country:US
Mailing Address - Phone:915-595-2286
Mailing Address - Fax:915-595-2248
Practice Address - Street 1:10201 GATEWAY WEST BLVD
Practice Address - Street 2:STE 210
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7652
Practice Address - Country:US
Practice Address - Phone:915-595-2286
Practice Address - Fax:915-595-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07841900207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty