Patrick Ajiboye, MD

Individual provider Active NPI Internal Medicine Physician · Meridian, MS

NPI 1205913902 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1205913902
Entity type
Individual (NPI type 1)
Primary specialty
Internal Medicine Physician 207R00000X
License
17420 (MS)
Practice address
2701 Davis St
Meridian, MS 39301-5708
Phone
(601) 693-0118
Fax
(601) 553-8175
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17420MSMDInternal Medicine Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 17420 MS Yes

Addresses

Primary practice location

2701 Davis St
Meridian, MS 39301-5708

Mailing address

4501 Highway 39 N Apt 11H
Meridian, MS 39301-1075
Phone (601) 693-0118

Other identifiers

IdentifierTypeStateIssuer
00125514MedicaidMS

Other providers in Meridian, MS

All providers in Meridian, MS · Internal Medicine Physician in Mississippi

Sources for this page

Verify at the official NPI Registry.