Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2003024384 | MO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2003024384 | MO |
NPI | 1144251679 |
---|---|
Provider Name | Akeeb Adedokun |
First Address | Fenton, MO 63026-5868 |
Second Address | Fenton, MO 63026-5868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 21/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
196690 | BLUE CROSS BLUE SHIELD (01) | |
208784009 | (05) | MO |
I00214 | (02) | MO |