Provider Demographics
NPI:1609132992
Name:DRO MD, PA
Entity Type:Organization
Organization Name:DRO MD, PA
Other - Org Name:DR O MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TINUADE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUSEGUN-GBADEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-853-2790
Mailing Address - Street 1:1202 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-853-2790
Mailing Address - Fax:210-314-6293
Practice Address - Street 1:1202 E SONTERRA BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-853-2790
Practice Address - Fax:210-314-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
TXN3663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty