Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | K7235 | TX |
N | 207R00000X | Internist | K7235 | TX |
N | 111NI0900X | Internist | K7235 | TX |
N | 208D00000X | General Practice Physician | K7235 | TX |
NPI | 1023122371 |
---|---|
Provider Name | Dr. Samuel A Adesoba |
First Address | Houston, TX 77271 |
Second Address | Houston, TX 77096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 19/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138035423 | (05) | TX |
G51807 | (02) | TX |