Provider Demographics
NPI:1922047422
Name:AGBETOYIN, ADEYINKA ADEBAYO (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEYINKA
Middle Name:ADEBAYO
Last Name:AGBETOYIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2968 NORTH HIGHLAND AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3609
Mailing Address - Country:US
Mailing Address - Phone:731-256-1819
Mailing Address - Fax:731-664-4330
Practice Address - Street 1:2968 NORTH HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-256-1819
Practice Address - Fax:731-664-4330
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36918207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
7638433OtherAETNA
TN4160707OtherBLUE CROSS BLUE SHIELD
TN87726OtherUNITED HEALTH
TNP00440784OtherRAILROAD MEDICARE
TN41719OtherTLC
TNP00440784OtherRAILROAD MEDICARE