Provider Demographics
NPI:1518022235
Name:PECOS T. OLURIN MD, PA
Entity Type:Organization
Organization Name:PECOS T. OLURIN MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMIDAYO
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLURIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-654-4800
Mailing Address - Street 1:1403 N RODNEY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4218
Mailing Address - Country:US
Mailing Address - Phone:302-654-4800
Mailing Address - Fax:302-984-0440
Practice Address - Street 1:1403 N RODNEY ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4218
Practice Address - Country:US
Practice Address - Phone:302-654-4800
Practice Address - Fax:302-984-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005400207R00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG01126Medicare PIN