Provider Demographics
NPI:1508111212
Name:FASANYA, ADEBAYO AYODEJI (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEBAYO
Middle Name:AYODEJI
Last Name:FASANYA
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 1:4300 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904-7028
Mailing Address - Country:US
Mailing Address - Phone:479-208-4601
Mailing Address - Fax:479-401-2643
Practice Address - Street 1:4300 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-7028
Practice Address - Country:US
Practice Address - Phone:412-208-4601
Practice Address - Fax:479-401-2643
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10794207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine