Healthcare Provider Details

I. General information

NPI: 1326075524
Provider Name (Legal Business Name): PETER CHUKWUEMEKA OKOSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CYPRESSWOOD DR
SPRING TX
77388-6038
US

IV. Provider business mailing address

1007 COWARDS CREEK DR
FRIENDSWOOD TX
77546-4409
US

V. Phone/Fax

Practice location:
  • Phone: 832-286-1664
  • Fax: 832-826-1849
Mailing address:
  • Phone: 832-606-9613
  • Fax: 713-330-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ2714
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: