Healthcare Provider Details

I. General information

NPI: 1467551531
Provider Name (Legal Business Name): BABATUNDE FRANCIS FAGBAMIYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 MEMORIAL DR # 94B
WACO TX
76711-1329
US

IV. Provider business mailing address

1320 ARROWFEATHER PASS
LEANDER TX
78641-1459
US

V. Phone/Fax

Practice location:
  • Phone: 254-297-3575
  • Fax:
Mailing address:
  • Phone: 478-258-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR3504
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number056058
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: