Provider Demographics
NPI:1548440316
Name:OREBANWO, BANDELE OLATOKUNBO (MD)
Entity type:Individual
Prefix:DR
First Name:BANDELE
Middle Name:OLATOKUNBO
Last Name:OREBANWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 HOSPITAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2452
Mailing Address - Country:US
Mailing Address - Phone:386-586-4280
Mailing Address - Fax:386-586-4286
Practice Address - Street 1:21 HOSPITAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2452
Practice Address - Country:US
Practice Address - Phone:386-586-4280
Practice Address - Fax:386-586-4286
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine