Provider Demographics
NPI:1255398806
Name:ARUBUOLA, OLUFISAYO E (MD)
Entity type:Individual
Prefix:DR
First Name:OLUFISAYO
Middle Name:E
Last Name:ARUBUOLA
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:PO BOX 16574
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6574
Mailing Address - Country:US
Mailing Address - Phone:904-881-1242
Mailing Address - Fax:904-683-0909
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:904-881-1242
Practice Address - Fax:904-683-0909
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29243OtherBLUE CROSS
GA472253813AMedicaid
FL268713500Medicaid
FL268713500Medicaid
P00178826Medicare PIN
FLH97834Medicare UPIN
P00153260Medicare PIN