Individual
ASHTON ADEKUNLE ADEKANMBI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 WALTERS ST, LAKE CHARLES, LA 70607-4647
(337) 480-8066
(337) 480-8161
Mailing address
PO BOX 122108 DEPT 2108, DALLAS, TX 75312-7732
(337) 480-8066
(337) 480-8161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
323422
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2442325
—
LA
01
—
MD.323422
STATE LICENSE
LA
Enumeration date
03/27/2017
Last updated
02/17/2022
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