Healthcare Provider Details

I. General information

NPI: 1790163764
Provider Name (Legal Business Name): CLAYTON OKPARA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18951 N MEMORIAL DR
HUMBLE TX
77338-4217
US

IV. Provider business mailing address

18951 N MEMORIAL DR
HUMBLE TX
77338-4217
US

V. Phone/Fax

Practice location:
  • Phone: 281-540-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1790163764
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR5302
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10052481
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberR5302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: