Provider Demographics
NPI:1821224825
Name:GASTROENTEROLOGY PRACTICE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY PRACTICE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIODUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-468-7200
Mailing Address - Street 1:301 HIGHLANDER BLVD.
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1164
Mailing Address - Country:US
Mailing Address - Phone:817-468-7200
Mailing Address - Fax:817-468-7201
Practice Address - Street 1:301 HIGHLANDER BLVD.
Practice Address - Street 2:SUITE 121
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1164
Practice Address - Country:US
Practice Address - Phone:817-468-7200
Practice Address - Fax:817-468-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2238207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI13283Medicare UPIN