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General NPI Number Information
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NPI Number | 1417009242
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Entity Type | Individual
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Provider Name | ADEBAYO JERRY ADESOMO M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3101 RICHMOND AVE STE 250
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City | HOUSTON
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State | TX
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Zip | 77098-3098
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Country | US
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Telephone | 713-526-6500
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Fax | 713-526-0598
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Provider Business Mailing Address
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Address Line | 3101 RICHMOND AVE STE 250
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City | HOUSTON
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State | TX
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Zip | 77098-3098
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Country | US
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Telephone | 713-526-6500
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Fax | 713-526-0598
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | F8387
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License Number State | TX
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