Individual
OLUBUKUNOLA ADESANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 S COULTER ST, AMARILLO, TX 79106-1786
(806) 354-5630
(806) 354-5689
Mailing address
1400 WALLACE BLVD, ATTN: CREDENTIALING DEPT, AMARILLO, TX 79106-1708
(806) 354-5630
(806) 354-5689
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
2003-0634
NM
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
N4234
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200340390 A
—
OK
05
—
220514801
—
TX
05
—
220514802
—
TX
05
—
47426781
—
NM
01
—
NM009K99
BXBS PHYSICIAN
NM
Enumeration date
09/15/2006
Last updated
07/17/2013
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