Healthcare Provider Details

I. General information

NPI: 1104900067
Provider Name (Legal Business Name): FIRST FRUITS MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 E HOUSTON ST
BEEVILLE TX
78102-5207
US

IV. Provider business mailing address

1211 E HOUSTON ST
BEEVILLE TX
78102-5207
US

V. Phone/Fax

Practice location:
  • Phone: 361-358-8982
  • Fax: 361-358-2176
Mailing address:
  • Phone: 361-358-8982
  • Fax: 361-358-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: CHRISTIAN N OKPALO
Title or Position: PRESIDENT
Credential: MD
Phone: 361-358-8982