Provider Demographics
NPI:1609225341
Name:ESHO, BUKOLA
Entity Type:Individual
Prefix:
First Name:BUKOLA
Middle Name:
Last Name:ESHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 11TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4332
Mailing Address - Country:US
Mailing Address - Phone:940-263-3000
Mailing Address - Fax:940-263-3018
Practice Address - Street 1:1631 11TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4332
Practice Address - Country:US
Practice Address - Phone:940-263-3000
Practice Address - Fax:940-263-3018
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268214207R00000X
TXS0282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine