Provider Demographics
NPI:1316931140
Name:OPAWUMI, DAVID O (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:O
Last Name:OPAWUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10201 GATEWAY WEST BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7652
Mailing Address - Country:US
Mailing Address - Phone:972-591-2922
Mailing Address - Fax:915-591-0495
Practice Address - Street 1:10201 GATEWAY WEST BLVD
Practice Address - Street 2:STE 210
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7652
Practice Address - Country:US
Practice Address - Phone:972-591-2922
Practice Address - Fax:915-591-0495
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07841900207R00000X
TXM8227207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0067938Medicaid
NJ087754Medicare PIN
P00480299Medicare PIN
NJI24572Medicare UPIN
NJ0067938Medicaid