Healthcare Provider Details

I. General information

NPI: 1508500414
Provider Name (Legal Business Name): ABIODUN JOSEPH ABIOYE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date: 01/30/2023
Reactivation Date: 02/08/2023

III. Provider practice location address

7301 ROGERS AVE MERCY FORT SMITH
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

7301 ROGERS AVE MERCY FORT SMITH ATTN GME DEPARTMENT
FORT SMITH AR
72903-4100
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-6000
  • Fax: 479-314-4705
Mailing address:
  • Phone: 479-314-6000
  • Fax: 479-314-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberV7174
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV7174
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: