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NPI Code Detail

MEDICARE: EBENEZER O BABALOLA M.D.

MEDICARE: EBENEZER O BABALOLA 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
1207VF0040XUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician277987NY
2207V00000XObstetrics & Gynecology PhysicianR2275TX
3207V00000XObstetrics & Gynecology Physician277987NY
4207VF0040XUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianR2275TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780655175
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBENEZER O BABALOLA M.D.
Provider Business Mailing Address
First Line : 919 LOCKE ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78208-2127
Country : US
Telephone Number : 210-644-8700
Fax Number : 210-702-4326
Provider Business Practice Location Address
First Line : 919 LOCKE ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78208-2127
Country : US
Telephone Number : 210-358-8255
Fax Number : 210-644-8726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 01/05/2026

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Directions to “ EBENEZER O BABALOLA M.D.” Practice Location

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