Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | N1971 | TX |
N | 208000000X | Pediatrician | N1971 | TX |
NPI | 1164688966 |
---|---|
Provider Name | Dr. Olutola O. Adetona |
First Address | San Antonio, TX 78240-1655 |
Second Address | San Antonio, TX 78240-1655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 04/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
194042103 | (05) | TX |
8CA599 | BCBS (01) | TX |