Healthcare Provider Details

I. General information

NPI: 1942443312
Provider Name (Legal Business Name): JAMES ANTWI OWUSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MEDICAL PLAZA DR
SHENANDOAH TX
77380-3242
US

IV. Provider business mailing address

6431 FANNIN ST MSB 5.036
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-5000
  • Fax:
Mailing address:
  • Phone: 713-500-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301104429
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberQ5240
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number0101260680
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: