Provider Demographics
NPI:1760433908
Name:OGUNDIPE, AKINOLA O (MD)
Entity Type:Individual
Prefix:MR
First Name:AKINOLA
Middle Name:O
Last Name:OGUNDIPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2911
Mailing Address - Country:US
Mailing Address - Phone:580-767-1300
Mailing Address - Fax:580-765-4529
Practice Address - Street 1:609 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2911
Practice Address - Country:US
Practice Address - Phone:580-767-1300
Practice Address - Fax:580-765-4529
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24516174400000X, 207RH0003X, 207RH0000X
OK18134207RH0003X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522146Medicare ID - Type Unspecified
OK110158514Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OKF12220Medicare UPIN
KS100383900CMedicaid
KS102500Medicare ID - Type Unspecified
OK100746610AMedicaid
OK100012180AMedicaid