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General NPI Number Information
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NPI Number | 1295048528
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Entity Type | Individual
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Provider Name | BENJAMIN WOWO MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 424 PARK GROVE LANE
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City | KATY
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State | TX
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Zip | 77450-1571
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Country | US
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Telephone | 329-133-7651
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Fax |
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Provider Business Mailing Address
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Address Line | 3407 GRAND PEBBLE LN
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City | KATY
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State | TX
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Zip | 77494-0707
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Country | US
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Telephone | 917-434-7735
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD441257
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | P9770
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | P9770
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License Number State | TX
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