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General NPI Number Information
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NPI Number | 1205141884
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Entity Type | Individual
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Provider Name | HEZEKIAH OLUWAROTIMI SOBAMOWO MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2010
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 10730 POTRANCO RD STE 122-507
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3327
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Country | US
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Telephone | 337-433-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 501 DR MICHAEL DEBAKEY DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5724
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Country | US
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Telephone | 337-433-8400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 204750
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | FR0435669053
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD.204750
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | P1595
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | P1595
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License Number State | TX
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