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General NPI Number Information
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NPI Number | 1235275900
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Entity Type | Individual
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Provider Name | PROSPERITY EZEANUNA MD
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 1673 BRIARCREST DR STE 100B
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City | BRYAN
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State | TX
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Zip | 77802-2756
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Country | US
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Telephone | 979-985-5339
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Fax | 979-705-3505
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Provider Business Mailing Address
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Address Line | 1673 BRIARCREST DR STE 100B
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City | BRYAN
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State | TX
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Zip | 77802-2756
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Country | US
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Telephone | 979-985-5339
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Fax | 979-705-3505
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | N4405
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License Number State | TX
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