Doctor Name: | DR. OLADELE ADEPITAN ADEBOGUN |
NPI Number: | 1104822097 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD. PA. |
License Number: | N6128 |
Business Practice Address: | 2904 Arkansas Blvd Texarkana, AR - 718542536 |
Business Phone Number: | 8707734655 |
Business Fax Number: | 8707724650 |
Mailing Address: | 2904 Arkansas Blvd, TEXARKANA |
State: | AR |
Postal Code: | 718542536 |
Phone Number: | 8707734655 |
Fax Number: | 8707724650 |
NPI Enumeration Date: | 06/24/2005 |
NPI Last Update Date: | 03/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | N6128 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |