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General NPI Number Information
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NPI Number | 1891083689
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Entity Type | Individual
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Provider Name | RAPHAEL EZERA NWOJO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 02/03/2019
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Provider Practice Location Address
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Address Line | 540 W 5TH ST SUITE 410
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City | ODESSA
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State | TX
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Zip | 79761-5034
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Country | US
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Telephone | 432-333-8801
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Fax | 432-333-8136
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Provider Business Mailing Address
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Address Line | PO BOX 2129
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City | ODESSA
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State | TX
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Zip | 79760-2129
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Country | US
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Telephone | 432-333-8808
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Fax | 432-333-8136
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | TRN16148
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | Q6353
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License Number State | TX
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