Provider Demographics
NPI:1164688966
Name:ADETONA, OLUTOLA O (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUTOLA
Middle Name:O
Last Name:ADETONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 HUEBNER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1655
Mailing Address - Country:US
Mailing Address - Phone:210-697-3900
Mailing Address - Fax:210-697-3904
Practice Address - Street 1:9480 HUEBNER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1655
Practice Address - Country:US
Practice Address - Phone:210-697-3900
Practice Address - Fax:210-697-3904
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1971207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CA599OtherBCBS
TX194042103Medicaid
TX8CA599OtherBCBS