Basic Information
| Provider Information | |||||||||
| NPI: | 1134417736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ONAWUNMI | ||||||||
| FirstName: | GBONJUBOLA | ||||||||
| MiddleName: | OLUWATOYIN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | OYEFESO | ||||||||
| OtherFirstName: | GBONJUBOLA | ||||||||
| OtherMiddleName: | OLUWATOYIN | ||||||||
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| OtherCredential: | M.D | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 W MAGNOLIA AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761047657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177022450 | ||||||||
| FaxNumber: | 8177028445 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 S MAIN ST STE 501 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761044909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177023982 | ||||||||
| FaxNumber: | 8179273982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2011 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RP1001X | P9237 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | P9237 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.