Basic Information
| Provider Information | |||||||||
| NPI: | 1518384619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMOLE | ||||||||
| FirstName: | OLUWATOSIN | ||||||||
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| Credential: | M.D, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 87 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103589172 | ||||||||
| FaxNumber: | 2103589183 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 W MARTIN ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782070903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103583441 | ||||||||
| FaxNumber: | 2103585944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2014 | ||||||||
| LastUpdateDate: | 07/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R3169 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.