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General NPI Number Information
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NPI Number | 1245509108
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Entity Type | Individual
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Provider Name | ADEBAYO ADEWALE M.D
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Gender | Male
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 4002 S LOOP 256 STE F
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City | PALESTINE
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State | TX
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Zip | 75801-8493
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Country | US
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Telephone | 903-723-8210
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Fax | 903-723-8310
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Provider Business Mailing Address
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Address Line | 4002 S LOOP 256 STE F
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City | PALESTINE
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State | TX
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Zip | 75801-8493
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Country | US
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Telephone | 903-723-8210
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Fax | 903-723-8310
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 267748
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | Q0394
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License Number State | TX
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