Provider Demographics
NPI:1770979395
Name:DANIYAN, OPEOLUWA (MD)
Entity type:Individual
Prefix:DR
First Name:OPEOLUWA
Middle Name:
Last Name:DANIYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OPEOLUWA
Other - Middle Name:
Other - Last Name:FAWOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6278
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0278
Mailing Address - Country:US
Mailing Address - Phone:817-806-1140
Mailing Address - Fax:817-806-1141
Practice Address - Street 1:2302 LONE STAR RD STE 220
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8752
Practice Address - Country:US
Practice Address - Phone:682-341-7220
Practice Address - Fax:682-341-7222
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5351207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX414484201Medicaid
TX1D9463OtherMEDICARE