Healthcare Provider Details

I. General information

NPI: 1083871818
Provider Name (Legal Business Name): ABUMERE FOLASHADE AKINWALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 DATAPOINT DR
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

8410 DATAPOINT DR
SAN ANTONIO TX
78229-3220
US

V. Phone/Fax

Practice location:
  • Phone: 210-949-9733
  • Fax: 210-949-8925
Mailing address:
  • Phone: 210-949-9733
  • Fax: 210-949-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22016
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR4507
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number232032
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number22016
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberR4507
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: