Basic Information
| Provider Information | |||||||||
| NPI: | 1467427054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADEDOKUN | ||||||||
| FirstName: | ADE | ||||||||
| MiddleName: | LATEEF | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 961205 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761611205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177408450 | ||||||||
| FaxNumber: | 8173783699 | ||||||||
| Practice Location | |||||||||
| Address1: | 6116 OAKBEND TRL STE 112 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761323926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174239054 | ||||||||
| FaxNumber: | 8174239719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204R00000X | K5755 | TX | N | Allopathic & Osteopathic Physicians | Electrodiagnostic Medicine | 2081S0010X | K5755 | TX | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 208VP0000X | K5755 | TX | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208100000X | K5755 | TX | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.