Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 1036966 | TX |
NPI | 1295409936 |
---|---|
Provider Name | Olajumoke Fasipe |
First Address | Midlothian, TX 76065-7409 |
Second Address | Garland, TX 75043-5463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 13/10/2021 |