Individual
ABIMBOLA Y. AWODIPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1936 AMELIA CT, GERIATRIC CENTER & SENIOR SERVICES, DALLAS, TX 75235-7706
(214) 590-8369
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L9610
TX
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
L9610
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168390602
—
TX
05
—
168390604
—
TX
05
—
178299701
—
TX
01
—
8P9008
BLUE CROSS BLUE SHIELD
TX
Enumeration date
03/02/2006
Last updated
11/30/2012
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