Provider Demographics
NPI:1730302340
Name:LADAPO-WILSON, JUMOKE M (MD)
Entity Type:Individual
Prefix:MS
First Name:JUMOKE
Middle Name:M
Last Name:LADAPO-WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2138
Mailing Address - Street 2:716 N 10TH STREET
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-2138
Mailing Address - Country:US
Mailing Address - Phone:910-814-1212
Mailing Address - Fax:910-814-0303
Practice Address - Street 1:716 NORTH 10TH STREET
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:910-814-1212
Practice Address - Fax:910-814-0303
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200800512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1509TOtherBCBS
NC5911249Medicaid
NC1509TOtherBCBS