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General NPI Number Information
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NPI Number | 1306201900
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Entity Type | Organization
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Legal Business Name | AYODELE ABRAHAM MD PLLC
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 800 KIRNWOOD DR
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City | DESOTO
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State | TX
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Zip | 75115-2000
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Country | US
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Telephone | 972-632-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 7505 FOREST BEND DR
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City | PARKER
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State | TX
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Zip | 75002-6948
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Country | US
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Telephone | 972-632-0030
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST/OWNER
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Name | AYODELE ABRAHAM
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Credential | MD
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Telephone | 972-632-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M9770
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License Number State | TX
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