Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | K5755 | TX |
N | 2081S0010X | Sports Medicine | K5755 | TX |
N | 213ES0000X | Sports Medicine | K5755 | TX |
NPI | 1467427054 |
---|---|
Provider Name | Mr. Ade Lateef Adedokun |
First Address | Fort Worth, TX 76161-1205 |
Second Address | Fort Worth, TX 76132-3926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 26/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G70062 | (02) |