Healthcare Provider Details

I. General information

NPI: 1992369151
Provider Name (Legal Business Name): ASHLEY OKOTIE-EBOH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 STUDEMONT ST STE C2400
HOUSTON TX
77007-3803
US

IV. Provider business mailing address

1431 STUDEMONT ST STE C2400
HOUSTON TX
77007-3803
US

V. Phone/Fax

Practice location:
  • Phone: 713-242-2980
  • Fax: 713-862-5400
Mailing address:
  • Phone: 713-242-2980
  • Fax: 713-862-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT8906
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: