Healthcare Provider Details

I. General information

NPI: 1376807362
Provider Name (Legal Business Name): MAVIS TWUM-BARIMAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 W UNIVERSITY BLVD
ODESSA TX
79764-8530
US

IV. Provider business mailing address

PO BOX 2129
ODESSA TX
79760-2129
US

V. Phone/Fax

Practice location:
  • Phone: 432-640-6600
  • Fax: 432-640-4791
Mailing address:
  • Phone: 432-640-6600
  • Fax: 432-640-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ3982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: