Provider Demographics
NPI:1962508952
Name:ISIAKA, OLADOYIN (PA-C, RRT)
Entity Type:Individual
Prefix:
First Name:OLADOYIN
Middle Name:
Last Name:ISIAKA
Suffix:
Gender:F
Credentials:PA-C, RRT
Other - Prefix:
Other - First Name:OLADOYIN
Other - Middle Name:
Other - Last Name:OGUNBADEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8128 ROYAL TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-5074
Mailing Address - Country:US
Mailing Address - Phone:254-855-4188
Mailing Address - Fax:
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:214-590-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70097227900000X
TX03608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered