MEDICARE: ASHLEY OKOTIE-EBOH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	T8906	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204923281	OTHER	TX	TAX ID

General Provider Information

NPI Number	:	1992369151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY OKOTIE-EBOH MD

Provider Business Mailing Address
First Line	:	1431 STUDEMONT ST STE C2400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3803
Country	:	US
Telephone Number	:	713-242-2980
Fax Number	:	713-862-5400

Provider Business Practice Location Address
First Line	:	1431 STUDEMONT ST STE C2400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3803
Country	:	US
Telephone Number	:	713-242-2980
Fax Number	:	713-862-5400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	09/19/2024

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