Provider Demographics
NPI:1760737142
Name:OLA-PETERS, TOMI OMOLARA (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMI
Middle Name:OMOLARA
Last Name:OLA-PETERS
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 1:752 N MAIN ST UNIT 1797
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3399
Mailing Address - Country:US
Mailing Address - Phone:682-283-7381
Mailing Address - Fax:
Practice Address - Street 1:2700 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5899
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10044204207R00000X
TXQ3257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FM194OtherBCBS
TX345477902Medicaid
TXP01599389OtherRAILROAD MEDICARE
TXP01599389OtherRAILROAD MEDICARE