Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | E-12680 | AR |
NPI | 1003259979 |
---|---|
Provider Name | Adedamola Adepoju |
First Address | Sherwood, AR 72120-6015 |
Second Address | Sherwood, AR 72120-6015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 30/07/2020 |