Provider Demographics
NPI:1134380470
Name:ADEGOKE, RUEBEN A (MD)
Entity type:Individual
Prefix:
First Name:RUEBEN
Middle Name:A
Last Name:ADEGOKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:775-356-9393
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:1050 W GALLERIA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4800
Practice Address - Country:US
Practice Address - Phone:702-963-7000
Practice Address - Fax:702-333-8466
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61736207V00000X
WI65197207V00000X
NV12832207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1134380470Medicaid
NV4301084299OtherMICHIGAN LICENSE #
NVEA938ZOtherPTAN