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General NPI Number Information
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NPI Number | 1124080288
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Entity Type | Individual
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Provider Name | ADEBOLA O ADESANYA MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 3101 N TARRANT PKWY
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City | FORT WORTH
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State | TX
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Zip | 76177-8601
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Country | US
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Telephone | 817-639-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 N MACARTHUR BLVD STE 122-228
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City | IRVING
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State | TX
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Zip | 75038-6419
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Country | US
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Telephone | 888-484-8123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | K1331
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K1331
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | K1331
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License Number State | TX
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