Provider Demographics
NPI:1922365279
Name:ETA, BUKOLA GANIYAT (MD)
Entity Type:Individual
Prefix:
First Name:BUKOLA
Middle Name:GANIYAT
Last Name:ETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BUKOLA
Other - Middle Name:GANIYAT
Other - Last Name:ARIJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1521 RAINBOW DR
Mailing Address - Street 2:ANESTHESIA ASSOCIATES PA
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5395
Mailing Address - Country:US
Mailing Address - Phone:256-546-5281
Mailing Address - Fax:
Practice Address - Street 1:1521 RAINBOW DR
Practice Address - Street 2:ANESTHESIA ASSOCIATES PA
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5395
Practice Address - Country:US
Practice Address - Phone:256-546-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35132207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology