Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | K2394 | TX |
N | 111NI0900X | Internist | K2394 | TX |
N | 207RC0200X | Critical Care Medicine | K2394 | TX |
Y | 207RP1001X | Pulmonary Disease | K2394 | TX |
NPI | 1073583076 |
---|---|
Provider Name | Dr. Adesubomi Agoro |
First Address | Fort Worth, TX 76104-2120 |
Second Address | Fort Worth, TX 76104-2120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 02/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045359901 | (05) | TX |
G08509 | (02) | TX |