| Doctor Name: | DR. OLATUBOSUN FASHORO |
| NPI Number: | 1700823598 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 9436 |
| Business Practice Address: | 323 S Minnesota St Crookston, MN - 567161601 |
| Business Phone Number: | 2182819553 |
| Business Fax Number: | 2182819509 |
| Mailing Address: | 323 S Minnesota St, CROOKSTON |
| State: | MN |
| Postal Code: | 567161601 |
| Phone Number: | 2182819553 |
| Fax Number: | 2182819509 |
| NPI Enumeration Date: | 06/01/2006 |
| NPI Last Update Date: | 02/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 9436 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |