Provider Demographics
NPI:1508856204
Name:DUROJAIYE, ABIODUN O
Entity Type:Individual
Prefix:
First Name:ABIODUN
Middle Name:O
Last Name:DUROJAIYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 AUDELIA RD
Mailing Address - Street 2:SUITE B103
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9030
Mailing Address - Country:US
Mailing Address - Phone:214-340-3326
Mailing Address - Fax:214-340-5116
Practice Address - Street 1:11020 AUDELIA RD
Practice Address - Street 2:SUITE B103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9030
Practice Address - Country:US
Practice Address - Phone:214-340-3326
Practice Address - Fax:214-340-5116
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0066979332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508856204OtherBLUE CROSS BLUE SHIELD
TX4707330001Medicare NSC