Provider Demographics
NPI:1316174055
Name:ABISOGUN MUSA, ADETOUN A (MD)
Entity type:Individual
Prefix:
First Name:ADETOUN
Middle Name:A
Last Name:ABISOGUN MUSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADETOUN
Other - Middle Name:ABIMBOLA
Other - Last Name:ABISOGUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 SW MILITARY DRIVE, SUITE E
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255
Mailing Address - Country:US
Mailing Address - Phone:210-847-9324
Mailing Address - Fax:
Practice Address - Street 1:660 SW MILITARY DR STE E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1671
Practice Address - Country:US
Practice Address - Phone:210-847-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-21
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ33182084N0400X
NY2694142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology