Provider Demographics
NPI:1144707118
Name:ADEGBOKUN, ADEDOTUN E
Entity type:Individual
Prefix:
First Name:ADEDOTUN
Middle Name:E
Last Name:ADEGBOKUN
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 1:3000 EVANGELINE ST APT 137
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3833
Mailing Address - Country:US
Mailing Address - Phone:985-415-1681
Mailing Address - Fax:
Practice Address - Street 1:3000 EVANGELINE ST APT 137
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3833
Practice Address - Country:US
Practice Address - Phone:985-415-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)