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General NPI Number Information
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NPI Number | 1245320480
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Entity Type | Individual
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Provider Name | BOLANLE O. GBADEBO MD
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 9939 STATE HIGHWAY 151
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City | SAN ANTONIO
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State | TX
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Zip | 78251-1900
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Country | US
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Telephone | 210-949-9702
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Fax | 210-443-0333
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Provider Business Mailing Address
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Address Line | 7400 MERTON MINTER ST
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4404
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Country | US
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Telephone | 920-217-0539
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 46201
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28814
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License Number State | AL
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