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1124296132

NPI Code Detail

MEDICARE: ADEBOLA TEMITOPE IFAFORE M.D

MEDICARE: ADEBOLA TEMITOPE IFAFORE M.D

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	207P00000X	Emergency Medicine Physician	P4966	TX
2	207P00000X	Emergency Medicine Physician	046170	CT

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
2	P01246225	OTHER	TX	RAIL ROAD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8DQ931	OTHER	TX	BCBS
5	8DQ932	OTHER	TX	BCBS
6	P01246215	OTHER	TX	RAIL ROAD
7	P01246267	OTHER	TX	RAIL ROAD
8	P01478949	OTHER	TX	RAIL ROAD
9	8DP930	OTHER	TX	BCBS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	8FB278	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1124296132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEBOLA TEMITOPE IFAFORE M.D

Provider Business Mailing Address
First Line	:	PO BOX 841656
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7522
Country	:	US
Telephone Number	:	903-531-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E DAWSON ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2036
Country	:	US
Telephone Number	:	903-531-5000
Fax Number	:

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

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	08/07/2015

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Directions to “ ADEBOLA TEMITOPE IFAFORE M.D” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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