Basic Information
| Provider Information | |||||||||
| NPI: | 1922015692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROJUGBOKAN | ||||||||
| FirstName: | ADEBOLA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 160 | ||||||||
| Address2: | |||||||||
| City: | GOOSE CREEK | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294450160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437532334 | ||||||||
| FaxNumber: | 8437537986 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 ST JAMES AVE | ||||||||
| Address2: | |||||||||
| City: | GOOSE CREEK | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294452923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437532334 | ||||||||
| FaxNumber: | 8437537986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21082 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 210827 | 05 | SC | MEDICAID | H010516494 | 01 | SC | MEDICARE PIN FETTER HEALTH CARE NETWORK | OTHER |