Provider Demographics
NPI:1508126442
Name:AYO ADU M D PLLC
Entity Type:Organization
Organization Name:AYO ADU M D PLLC
Other - Org Name:ADU SPORTS MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-582-7900
Mailing Address - Street 1:9410 NE ZAC LENTZ PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904
Mailing Address - Country:US
Mailing Address - Phone:361-582-7900
Mailing Address - Fax:361-582-7902
Practice Address - Street 1:9410 NE ZAC LENTZ PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904
Practice Address - Country:US
Practice Address - Phone:361-582-7900
Practice Address - Fax:361-582-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1256207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty