Healthcare Provider Details

I. General information

NPI: 1407826498
Provider Name (Legal Business Name): OYEYEMI ADETOKUNBO FABUYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 SOUTH ADAMS STREET, SUITE 200
FORT WORTH TX
76104-2151
US

IV. Provider business mailing address

P.O. BOX 961205
FORT WORTH TX
76161-1205
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-7600
  • Fax: 817-332-7606
Mailing address:
  • Phone: 817-740-8400
  • Fax: 817-378-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL9188
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberL9188
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberL9188
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberL9188
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: