Healthcare Provider Details

I. General information

NPI: 1295998748
Provider Name (Legal Business Name): OLUSEGUN ADEBAYO COKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ADEBAYO OLUSEGUN COKER MD

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N. BALLAS RD SUITE 226A
SAINT LOUIS MO
63131
US

IV. Provider business mailing address

3009 N. BALLAS RD SUITE 226A
SAINT LOUIS MO
63131
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-4900
  • Fax: 314-996-4901
Mailing address:
  • Phone: 314-996-4900
  • Fax: 314-996-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.128162
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: