Provider Demographics
NPI:1386823995
Name:ADEDAPO, RAYMOND T (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:T
Last Name:ADEDAPO
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 1:12805 CULLEN BLVD
Mailing Address - Street 2:BUILDING B SUITE E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-3759
Mailing Address - Country:US
Mailing Address - Phone:281-397-3799
Mailing Address - Fax:409-283-2643
Practice Address - Street 1:12805 CULLEN BLVD
Practice Address - Street 2:BUILDING B SUITE E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-3759
Practice Address - Country:US
Practice Address - Phone:281-397-3799
Practice Address - Fax:281-397-3798
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2171266-02Medicaid
TX2171266-02Medicaid