Healthcare Provider Details

I. General information

NPI: 1891352472
Provider Name (Legal Business Name): OMARE S OKOTIE-EBOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NORTH LOOP W STE 30
HOUSTON TX
77008-1445
US

IV. Provider business mailing address

1801 NORTH LOOP W STE 30
HOUSTON TX
77008-1445
US

V. Phone/Fax

Practice location:
  • Phone: 713-802-9781
  • Fax: 713-868-2193
Mailing address:
  • Phone: 713-802-9781
  • Fax: 713-868-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU6044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: