Provider Demographics
NPI:1942276001
Name:SOKUNBI, DOLAMU OLUMIDE BAMIDELE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOLAMU
Middle Name:OLUMIDE BAMIDELE
Last Name:SOKUNBI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:626 RUSSELL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1246
Mailing Address - Country:US
Mailing Address - Phone:936-552-7216
Mailing Address - Fax:936-552-7274
Practice Address - Street 1:626 RUSSELL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1246
Practice Address - Country:US
Practice Address - Phone:936-552-7216
Practice Address - Fax:936-552-7274
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7203207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113679803Medicaid
TX073BKOtherBCBS
TXF86783Medicare UPIN
TX0073BKMedicare ID - Type UnspecifiedMEDICARE