Healthcare Provider Details

I. General information

NPI: 1184159139
Provider Name (Legal Business Name): OLUDOTUN ADEGOKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S MAIN ST
JAMESTOWN NY
14701-6626
US

IV. Provider business mailing address

15 S MAIN ST
JAMESTOWN NY
14701-6626
US

V. Phone/Fax

Practice location:
  • Phone: 716-483-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number305942
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD474972
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: