Provider Demographics
NPI:1295047918
Name:OJELADE, OLUBUNMI A (MD)
Entity type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:A
Last Name:OJELADE
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 1:2604 SAINT MICHAEL DR
Mailing Address - Street 2:STE 340
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2379
Mailing Address - Country:US
Mailing Address - Phone:903-614-5112
Mailing Address - Fax:
Practice Address - Street 1:2604 SAINT MICHAEL DR
Practice Address - Street 2:STE 340
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2379
Practice Address - Country:US
Practice Address - Phone:903-614-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8061207Q00000X
GA70629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine