Provider Demographics
NPI:1477864932
Name:OLUPONA, DAMILOLA EWONUBARI (DO)
Entity Type:Individual
Prefix:
First Name:DAMILOLA
Middle Name:EWONUBARI
Last Name:OLUPONA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0254
Mailing Address - Country:US
Mailing Address - Phone:509-444-8888
Mailing Address - Fax:509-444-7806
Practice Address - Street 1:338 6TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2420
Practice Address - Country:US
Practice Address - Phone:208-848-8300
Practice Address - Fax:208-848-8303
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0716207Q00000X
WAOP60328681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine