Provider Demographics
NPI:1467485409
Name:MOKUOLU, ADEDAYO O (MD)
Entity Type:Individual
Prefix:
First Name:ADEDAYO
Middle Name:O
Last Name:MOKUOLU
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2625 WIGWAM PKWY
Mailing Address - Street 2:STE 112
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7326
Mailing Address - Country:US
Mailing Address - Phone:702-255-5900
Mailing Address - Fax:702-255-5980
Practice Address - Street 1:2625 WIGWAM PKWY
Practice Address - Street 2:STE 112
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7326
Practice Address - Country:US
Practice Address - Phone:702-255-5900
Practice Address - Fax:702-255-5980
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV12563207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVGY644YMedicare PIN