Provider Demographics
NPI:1568717510
Name:GBADEBO-GOYEA, ERNEST AYODELE (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:AYODELE
Last Name:GBADEBO-GOYEA
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 1:1111 S LINCOLN AVE UNIT 1563
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-5172
Mailing Address - Country:US
Mailing Address - Phone:618-698-5303
Mailing Address - Fax:
Practice Address - Street 1:2019 CEDARWOOD TRL
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-7802
Practice Address - Country:US
Practice Address - Phone:618-698-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3361094412084P0800X
TN000000002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry