Provider Demographics
NPI:1174796254
Name:TAIWO, JOSEPH BABAFEMI (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BABAFEMI
Last Name:TAIWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851591
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1591
Mailing Address - Country:US
Mailing Address - Phone:186-643-1644
Mailing Address - Fax:
Practice Address - Street 1:910 N GALLOWAY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2409
Practice Address - Country:US
Practice Address - Phone:186-643-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20551207P00000X
GA001637207Q00000X
IN01064214A207Q00000X, 208M00000X
TXN4774207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08584859Medicaid
TX8DH023OtherBCBS OF TX
IN200922230Medicaid
TXP01087657OtherRAILROAD MEDICARE
IN000000593162OtherANTHEM PROVIDER NUMBER
LA1882330Medicaid
IN200922230Medicaid
INP00736797Medicare PIN
IN815500Z4Medicare PIN
TX8DH023OtherBCBS OF TX