Individual
BENEDICT O OLUSOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 N HAMPTON RD, SUITE 100, DESOTO, TX 75115-2392
(972) 228-3677
(972) 228-3672
Mailing address
PO BOX 628, DESOTO, TX 75123-0628
(972) 228-3677
(972) 228-3672
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
J7118
TX
207Q00000X
Family Medicine Physician
Primary
J7118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0032QR
BCBS
TX
05
—
139957825
—
TX
Enumeration date
07/25/2006
Last updated
10/02/2012
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