Provider Demographics
NPI:1477583482
Name:ADEDEJI, MOSES OYEGOKE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:OYEGOKE
Last Name:ADEDEJI
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 1:310 ABBEY CT
Mailing Address - Street 2:APT A2
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 VETERANS AVENUE
Practice Address - Street 2:DIAGNOSTIC MEDICINE SERVICE (113)
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-523-5542
Practice Address - Fax:228-523-4902
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17620174400000X
OH35.081298174400000X
TXM0335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.081298OtherSTATE MEDICAL BOARD
TXM0335OtherBOARD OF MEDICAL EXAMINER
MS17620OtherBOARD OF MEDICAL LICENSUR