MEDICARE: DR. DARE VICTOR AJIBADE MD/PHD/MPH

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	2086S0122X	Plastic and Reconstructive Surgery Physician	MD462905	PA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	S2710	TX
3	2086S0122X	Plastic and Reconstructive Surgery Physician	MD210001748	DC
4	2086S0122X	Plastic and Reconstructive Surgery Physician	D0092927	MD
5	2086S0122X	Plastic and Reconstructive Surgery Physician	25MA09901800	NJ
6	2086S0122X	Plastic and Reconstructive Surgery Physician	0101273317	VA

General Provider Information

NPI Number	:	1275890816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARE VICTOR AJIBADE MD/PHD/MPH

Provider Business Mailing Address
First Line	:	1110 W GRAY ST STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-4157
Country	:	US
Telephone Number	:	713-518-1858
Fax Number	:	713-518-1858

Provider Business Practice Location Address
First Line	:	1110 W GRAY ST STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-4157
Country	:	US
Telephone Number	:	713-844-8413
Fax Number	:	713-844-8413

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

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	05/20/2026

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