Basic Information
| Provider Information | |||||||||
| NPI: | 1306273560 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADEBOGUN M.D., P. A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 270603 | ||||||||
| Address2: | |||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750270603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722217900 | ||||||||
| FaxNumber: | 9722217901 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 LONG PRAIRIE ROAD | ||||||||
| Address2: | 100 | ||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722217900 | ||||||||
| FaxNumber: | 9722217901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2013 | ||||||||
| LastUpdateDate: | 01/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | ADEBOGUN | ||||||||
| AuthorizedOfficialFirstName: | OLADELE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9722217900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A0401X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.