Provider Demographics
NPI:1194961904
Name:BAKARE, ADEWUMI (DMS, PA)
Entity type:Individual
Prefix:DR
First Name:ADEWUMI
Middle Name:
Last Name:BAKARE
Suffix:
Gender:M
Credentials:DMS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 N GALLOWAY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7535
Mailing Address - Country:US
Mailing Address - Phone:214-660-8554
Mailing Address - Fax:214-660-8634
Practice Address - Street 1:5115 N GALLOWAY AVE STE 203
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7535
Practice Address - Country:US
Practice Address - Phone:214-660-8554
Practice Address - Fax:214-660-8634
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11282363A00000X
GA10383363A00000X
CAPA59643363A00000X
UT12215796-1206363AM0700X
TXPA06380363AM0700X
MO2021021702363A00000X
NY013074363A00000X
OK3099363AM0700X
MI5601010504363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant