Healthcare Provider Details

I. General information

NPI: 1770613507
Provider Name (Legal Business Name): CHINASA PAUL ANUGWOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MEDICAL PLAZA DR SUITE 370
SHENANDOAH TX
77380-3260
US

IV. Provider business mailing address

43 GINGER JAR ST
THE WOODLANDS TX
77382-2806
US

V. Phone/Fax

Practice location:
  • Phone: 832-246-8935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49101
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP6574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: