Provider Demographics
NPI:1235183492
Name:ERINLE, AYODELE OLUMIDE (MD)
Entity Type:Individual
Prefix:DR
First Name:AYODELE
Middle Name:OLUMIDE
Last Name:ERINLE
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 1:1801 REDROCK DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5655
Mailing Address - Country:US
Mailing Address - Phone:505-863-7933
Mailing Address - Fax:505-863-9406
Practice Address - Street 1:1901 RED ROCK DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5683
Practice Address - Country:US
Practice Address - Phone:505-863-7933
Practice Address - Fax:505-863-9406
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062023207R00000X
PAMD427577207RG0300X
NMMD2007-0583207RN0300X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83432361Medicaid
NMNM00178Medicare PIN