Individual
SAMUEL ADEKUNLE ADEFEYISAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4314 CLAYTON ST, GRAND PRAIRIE, TX 75052-3433
(214) 708-9590
Mailing address
4314 CLAYTON ST, GRAND PRAIRIE, TX 75052-3433
(214) 708-9590
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
062934
GA
207L00000X
Anesthesiology Physician
83699
SC
207L00000X
Anesthesiology Physician
MD.29707
AL
208000000X
Pediatrics Physician
062934
GA
208000000X
Pediatrics Physician
MD.2009
AL
2080P0203X
Pediatric Critical Care Medicine Physician
062934
GA
2080P0203X
Pediatric Critical Care Medicine Physician
MD.29707
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q46839
—
SC
Enumeration date
05/24/2007
Last updated
12/16/2024
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