Provider Demographics
NPI:1467551531
Name:FAGBAMIYE, BABATUNDE FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BABATUNDE
Middle Name:FRANCIS
Last Name:FAGBAMIYE
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 1:1320 ARROWFEATHER PASS
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-1459
Mailing Address - Country:US
Mailing Address - Phone:478-258-5582
Mailing Address - Fax:
Practice Address - Street 1:4800 MEMORIAL DR # 94B
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:254-297-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR35042084P0800X
GA0560582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA742988049BMedicaid
GA52186848004OtherBCBS
GAI02038Medicare UPIN
GA26BDKNTMedicare PIN