Organization
ADESUBOMI AGORO M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADESUBOMI B AGORO M.D. (PRESIDENT)
(817) 763-5550
Entity
Organization
Contact information
Practice address
1339 EAST ST, GRAHAM, TX 76450-4228
(817) 763-5550
(817) 763-5715
Mailing address
PO BOX 150929, FORT WORTH, TX 76108-0929
(817) 763-5550
(817) 763-5715
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
K2394
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K2394
STATE LICENSE
TX
Enumeration date
01/12/2009
Last updated
07/16/2010
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