Provider Demographics
NPI:1386734721
Name:THOMAS, OLUBUKUNOLA COLLINS (MD)
Entity type:Individual
Prefix:DR
First Name:OLUBUKUNOLA
Middle Name:COLLINS
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 WARDELL PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6145
Mailing Address - Country:US
Mailing Address - Phone:407-671-0556
Mailing Address - Fax:407-671-0220
Practice Address - Street 1:4304 WARDELL PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6145
Practice Address - Country:US
Practice Address - Phone:407-671-0556
Practice Address - Fax:407-671-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87929208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6882ZMedicare ID - Type Unspecified
FLI49174Medicare UPIN