Provider Demographics
NPI:1275768566
Name:ADEDEJI, ADEBUKOLA (MD)
Entity Type:Individual
Prefix:
First Name:ADEBUKOLA
Middle Name:
Last Name:ADEDEJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11212 STATE HWY 151
Mailing Address - Street 2:SUITE 370 PLAZA 1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251
Mailing Address - Country:US
Mailing Address - Phone:210-339-2293
Mailing Address - Fax:210-545-3661
Practice Address - Street 1:11212 STATE HWY 151
Practice Address - Street 2:SUITE 370 PLAZA 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-339-2293
Practice Address - Fax:210-545-3661
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ0719208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery