Provider Demographics
NPI:1548220403
Name:SOKUNBI, MODUPE ARINUKE (MD)
Entity Type:Individual
Prefix:MRS
First Name:MODUPE
Middle Name:ARINUKE
Last Name:SOKUNBI
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 1:626 RUSSELL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-552-7216
Mailing Address - Fax:936-552-7274
Practice Address - Street 1:626 RUSSELL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965
Practice Address - Country:US
Practice Address - Phone:936-552-7216
Practice Address - Fax:936-552-7274
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000072BKOtherBCBS
F90878Medicare UPIN