Provider Demographics
NPI:1346435815
Name:AJALA, MOYOSADE ADEYINKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOYOSADE
Middle Name:ADEYINKA
Last Name:AJALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 E JOHN CARPENTER FWY
Mailing Address - Street 2:SUITE 850
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2727
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-957-3005
Practice Address - Street 1:410 E PIONEER PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4983
Practice Address - Country:US
Practice Address - Phone:469-733-1890
Practice Address - Fax:469-733-1894
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10027990390200000X
TXN8264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program