Basic Information
| Provider Information | |||||||||
| NPI: | 1669603031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGBOOLA | ||||||||
| FirstName: | SUNDAY | ||||||||
| MiddleName: | ABIODUN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3451 RIVER PARK DR | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761169575 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11801 SOUTH FWY | ||||||||
| Address2: | TEXAS HEALTH HUGELY HOSPITAL | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172939110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2009 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD446105 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | Q7996 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | MT195212 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | Q7996 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.