Healthcare Provider Details

I. General information

NPI: 1063631281
Provider Name (Legal Business Name): KWASI ADZOTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 JOE BATTLE BLVD SUITE 235
EL PASO TX
79938-2639
US

IV. Provider business mailing address

3270 JOE BATTLE BLVD SUITE 235
EL PASO TX
79938-2639
US

V. Phone/Fax

Practice location:
  • Phone: 915-504-6890
  • Fax: 915-849-1712
Mailing address:
  • Phone: 915-504-6890
  • Fax: 915-849-1712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number222413
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA102066
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberN8602
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberN8602
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: