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
| License | State | Type | Specialty |
|---|---|---|---|
| 17420 | MS | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00125514 | Medicaid | MS |
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All providers in Meridian, MS · Internal Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.