Provider Demographics
NPI:1790329381
Name:ABUDU, YEMISI DOCAS
Entity Type:Individual
Prefix:
First Name:YEMISI
Middle Name:DOCAS
Last Name:ABUDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ORION DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-0007
Mailing Address - Country:US
Mailing Address - Phone:254-630-7629
Mailing Address - Fax:
Practice Address - Street 1:400 W ORION DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-0007
Practice Address - Country:US
Practice Address - Phone:254-630-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10190794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine