MEDICARE: DR. OLAWALE ADETAYO MORAFA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	36735	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013901222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLAWALE ADETAYO MORAFA MD

Provider Business Mailing Address
First Line	:	2693 UNION AVENUE EXT
Second Line	:	SUITE 100
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4403
Country	:	US
Telephone Number	:	901-722-0088
Fax Number	:	901-722-0082

Provider Business Practice Location Address
First Line	:	2693 UNION AVENUE EXT
Second Line	:	SUITE 100
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4403
Country	:	US
Telephone Number	:	901-722-0088
Fax Number	:	901-722-0082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	03/06/2015

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