Provider Demographics
NPI:1942941307
Name:BABALOLA, ADEWALE A (NP)
Entity Type:Individual
Prefix:MR
First Name:ADEWALE
Middle Name:A
Last Name:BABALOLA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9418 HEFLIN COLONY DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7559
Mailing Address - Country:US
Mailing Address - Phone:281-772-7600
Mailing Address - Fax:
Practice Address - Street 1:9418 HEFLIN COLONY DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7559
Practice Address - Country:US
Practice Address - Phone:281-772-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX805730363L00000X
TXAP141282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1619116Medicaid