Provider Demographics
NPI:1831452952
Name:ALADEGBAMI, BOLA GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:BOLA
Middle Name:GABRIEL
Last Name:ALADEGBAMI
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 1:3417 GASTON AVE STE 965
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2036
Mailing Address - Country:US
Mailing Address - Phone:972-817-6050
Mailing Address - Fax:
Practice Address - Street 1:3417 GASTON AVE STE 965
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2036
Practice Address - Country:US
Practice Address - Phone:972-817-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012020063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery