Provider Demographics
NPI:1184711731
Name:JRAPHA HEALTHCARE SERVICES
Entity type:Organization
Organization Name:JRAPHA HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAWOLE
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:OLUWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-829-0098
Mailing Address - Street 1:13615 NEUTRON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4411
Mailing Address - Country:US
Mailing Address - Phone:972-829-0098
Mailing Address - Fax:972-436-0145
Practice Address - Street 1:13615 NEUTRON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4411
Practice Address - Country:US
Practice Address - Phone:972-829-0098
Practice Address - Fax:972-436-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160177504Medicaid
TX180514501Medicaid
H49228Medicare UPIN
00634ZMedicare PIN
TX180514501Medicaid