Healthcare Provider Details

I. General information

NPI: 1063677672
Provider Name (Legal Business Name): OKEZIE AGUORU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 S LOOP W STE 204
HOUSTON TX
77054-1371
US

IV. Provider business mailing address

PO BOX 1626
CYPRESS TX
77410-1626
US

V. Phone/Fax

Practice location:
  • Phone: 713-796-9500
  • Fax: 713-796-9504
Mailing address:
  • Phone: 713-796-9500
  • Fax: 713-796-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0067827
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN6131
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: