Provider Demographics
NPI:1225061104
Name:DOSU, BABATUNDE I (MD)
Entity Type:Individual
Prefix:DR
First Name:BABATUNDE
Middle Name:I
Last Name:DOSU
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:PO BOX 100801
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-0801
Mailing Address - Country:US
Mailing Address - Phone:817-386-9900
Mailing Address - Fax:
Practice Address - Street 1:900 JEROME STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3939
Practice Address - Country:US
Practice Address - Phone:817-922-0800
Practice Address - Fax:817-922-0805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5093208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125002908Medicaid
TX125002908Medicaid