Provider Demographics
NPI:1962792598
Name:OYEYEMI FABUYI M.D., P.A.
Entity type:Organization
Organization Name:OYEYEMI FABUYI M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OYEYEMI
Authorized Official - Middle Name:ADETOKUNBO
Authorized Official - Last Name:FABUYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-624-3063
Mailing Address - Street 1:221 W EXCHANGE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-9614
Mailing Address - Country:US
Mailing Address - Phone:817-624-3063
Mailing Address - Fax:817-263-5657
Practice Address - Street 1:508 S ADAMS ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2151
Practice Address - Country:US
Practice Address - Phone:817-624-3063
Practice Address - Fax:817-263-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9188207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL9188OtherSTATE LICENCE