Provider Demographics
NPI:1295967701
Name:OJEBODE, EZEKIEL ADEYANJU
Entity type:Individual
Prefix:MR
First Name:EZEKIEL
Middle Name:ADEYANJU
Last Name:OJEBODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 LYNDON B JOHNSON FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-3152
Mailing Address - Country:US
Mailing Address - Phone:214-778-7116
Mailing Address - Fax:
Practice Address - Street 1:11312 LYNDON B JOHNSON FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-3152
Practice Address - Country:US
Practice Address - Phone:214-778-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness