Provider Demographics
NPI:1437808763
Name:AJIBOLA, OLUWATOMI (MD)
Entity type:Individual
Prefix:
First Name:OLUWATOMI
Middle Name:
Last Name:AJIBOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N BELL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2216
Mailing Address - Country:US
Mailing Address - Phone:737-321-0200
Mailing Address - Fax:737-321-0201
Practice Address - Street 1:600 N BELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2216
Practice Address - Country:US
Practice Address - Phone:737-321-0200
Practice Address - Fax:737-321-0201
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT224883207Q00000X
PAMD491542208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine