Individual
ADEBOLA TEMITOPE IFAFORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-5000
Mailing address
PO BOX 841656, DALLAS, TX 75284-7522
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
046170
CT
207P00000X
Emergency Medicine Physician
Primary
P4966
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323250601
—
TX
05
—
323250602
—
TX
05
—
323250603
—
TX
05
—
323250604
—
TX
01
—
8DP930
BCBS
TX
01
—
8DQ931
BCBS
TX
01
—
8DQ932
BCBS
TX
01
—
8FB278
BCBS
TX
01
—
P01246215
RAIL ROAD
TX
01
—
P01246225
RAIL ROAD
TX
01
—
P01246267
RAIL ROAD
TX
01
—
P01478949
RAIL ROAD
TX
Enumeration date
02/12/2008
Last updated
08/07/2015
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