Provider Demographics
NPI:1922328079
Name:OKIN-AYILEKA, ABIODUN ADEJUMOKE (MD)
Entity Type:Individual
Prefix:
First Name:ABIODUN
Middle Name:ADEJUMOKE
Last Name:OKIN-AYILEKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 W LOUISIANA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5826
Mailing Address - Country:US
Mailing Address - Phone:432-400-3066
Mailing Address - Fax:432-400-3066
Practice Address - Street 1:3416 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6710
Practice Address - Country:US
Practice Address - Phone:432-400-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10037182207Q00000X
TXP4604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP4604OtherSTATE LICENSE