Individual
BOLAJI S. SOFOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
915 10TH AVE NW, ARDMORE, OK 73401-4025
(580) 226-8310
(580) 223-3911
Mailing address
PO BOX 1571, ARDMORE, OK 73402-1571
(580) 226-8310
(580) 223-3911
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
18035
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100102400A
—
OK
01
—
731521343
FEDERAL TAX NUMBER
OK
Enumeration date
04/15/2006
Last updated
01/16/2008
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