Provider Demographics
NPI:1720060106
Name:AKINYEYE, ADETOKUNBO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ADETOKUNBO
Middle Name:A
Last Name:AKINYEYE
Suffix:
Gender:M
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:PO BOX 2256
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-2256
Mailing Address - Country:US
Mailing Address - Phone:281-422-9967
Mailing Address - Fax:281-422-1032
Practice Address - Street 1:1661 ROLLINGBROOK DR
Practice Address - Street 2:SUITE A
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3666
Practice Address - Country:US
Practice Address - Phone:281-422-9967
Practice Address - Fax:281-422-1032
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00099854OtherMEDICARE RR
TX135327814Medicaid
TX8M1750OtherBLUE CROSS
TX163411502Medicaid
TX163411502Medicaid
TX8B3210Medicare PIN