Provider Demographics
NPI:1578762563
Name:OPEOLA, MOBOLAJI M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOBOLAJI
Middle Name:M
Last Name:OPEOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9018 CULEBRA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2891
Mailing Address - Country:US
Mailing Address - Phone:830-276-2600
Mailing Address - Fax:830-276-2626
Practice Address - Street 1:9018 CULEBRA RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2891
Practice Address - Country:US
Practice Address - Phone:830-276-2600
Practice Address - Fax:830-276-2626
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9555207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology