Provider Demographics
NPI:1033121967
Name:AYODELE, OYENIRAN A
Entity type:Individual
Prefix:
First Name:OYENIRAN
Middle Name:A
Last Name:AYODELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 OAK LN STE 202
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8241
Mailing Address - Country:US
Mailing Address - Phone:972-642-6777
Mailing Address - Fax:972-642-6707
Practice Address - Street 1:2305 OAK LN STE 202
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8241
Practice Address - Country:US
Practice Address - Phone:972-642-6777
Practice Address - Fax:972-642-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4897870002Medicare NSC