Provider Demographics
NPI:1730262015
Name:ADAMSON, FATAI GBOLADE (MD)
Entity type:Individual
Prefix:DR
First Name:FATAI
Middle Name:GBOLADE
Last Name:ADAMSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 DOUGLAS AVE
Mailing Address - Street 2:STE 135
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2573
Mailing Address - Country:US
Mailing Address - Phone:407-725-7087
Mailing Address - Fax:321-972-2779
Practice Address - Street 1:789 DOUGLAS AVE STE 135
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2573
Practice Address - Country:US
Practice Address - Phone:407-725-7087
Practice Address - Fax:321-372-2779
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 129617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020617600Medicaid
LA1583481Medicaid