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General NPI Number Information
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NPI Number | 1275768566
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Entity Type | Individual
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Provider Name | ADEBUKOLA ADEDEJI M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 09/18/2017
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Provider Practice Location Address
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Address Line | 11212 STATE HWY 151 SUITE 370 PLAZA 1
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City | SAN ANTONIO
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State | TX
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Zip | 78251
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Country | US
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Telephone | 210-339-2293
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Fax | 210-545-3661
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Provider Business Mailing Address
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Address Line | 11212 STATE HWY 151 SUITE 370 PLAZA 1
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City | SAN ANTONIO
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State | TX
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Zip | 78251
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Country | US
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Telephone | 210-339-2293
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Fax | 210-545-3661
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | Q0719
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License Number State | TX
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