Provider Demographics
NPI:1306273560
Name:ADEBOGUN M.D., P. A.
Entity type:Organization
Organization Name:ADEBOGUN M.D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLADELE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-221-7900
Mailing Address - Street 1:PO BOX 270603
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-0603
Mailing Address - Country:US
Mailing Address - Phone:972-221-7900
Mailing Address - Fax:972-221-7901
Practice Address - Street 1:2620 LONG PRAIRIE ROAD
Practice Address - Street 2:100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022
Practice Address - Country:US
Practice Address - Phone:972-221-7900
Practice Address - Fax:972-221-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty