MEDICARE: DR. OLADELE ADEPITAN ADEBOGUN MD. PA.

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	2084P0800X	Psychiatry Physician	E-1599	AR
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	N6128	TX
3	2084P0800X	Psychiatry Physician	N6128	TX

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	:	1104822097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLADELE ADEPITAN ADEBOGUN MD. PA.

Provider Business Mailing Address
First Line	:	2904 ARKANSAS BLVD
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-2536
Country	:	US
Telephone Number	:	870-773-4655
Fax Number	:	870-772-4650

Provider Business Practice Location Address
First Line	:	777 INTERNATIONAL PKWY STE 260
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-5303
Country	:	US
Telephone Number	:	972-221-7900
Fax Number	:	972-221-7901

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/11/2026

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