Healthcare Provider Details

I. General information

NPI: 1194256123
Provider Name (Legal Business Name): ADEJUYIGBE ADARALEGBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 DUNDAS DR
JACKSONVILLE FL
32218-5517
US

IV. Provider business mailing address

330 CORPORATE WAY STE 200
ORANGE PARK FL
32073-6214
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-8801
  • Fax: 833-578-1804
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-866-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME144231
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME144231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: