Individual
ADEBOLA O ADESANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3101 N TARRANT PKWY, FORT WORTH, TX 76177-8601
(817) 639-1000
Mailing address
4020 N MACARTHUR BLVD STE 122-228, IRVING, TX 75038-6419
(888) 484-8123
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
K1331
TX
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
K1331
TX
207R00000X
Internal Medicine Physician
K1331
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132360204
—
TX
05
—
132360207
—
TX
05
—
132360208
—
TX
Enumeration date
04/04/2006
Last updated
08/05/2020
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