Provider Demographics
NPI:1538588819
Name:EHANIRE, TOSANWUMI
Entity type:Individual
Prefix:DR
First Name:TOSANWUMI
Middle Name:
Last Name:EHANIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TOSAN
Other - Middle Name:ELEANOR
Other - Last Name:EHANIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2905 SAN GABRIEL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3548
Mailing Address - Country:US
Mailing Address - Phone:512-815-0123
Mailing Address - Fax:512-861-6206
Practice Address - Street 1:2905 SAN GABRIEL ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3548
Practice Address - Country:US
Practice Address - Phone:512-815-0123
Practice Address - Fax:512-861-6206
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1691208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT1691OtherSTATE LICENSE