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NPI Code Detail

MEDICARE: ADAEZE AZWE AGBOR PA-C

MEDICARE: ADAEZE AZWE AGBOR PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA06212TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA06212OTHERTXTEXAS MEDICAL BOARD

General Provider Information

NPI Number : 1154645752
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADAEZE AZWE AGBOR PA-C
Provider Business Mailing Address
First Line : 2120 ASHLAND ST
Second Line :
City : HOUSTON
State : TX
Zip : 77008-2418
Country : US
Telephone Number : 713-864-2659
Fax Number : 888-592-4044
Provider Business Practice Location Address
First Line : 2120 ASHLAND ST
Second Line :
City : HOUSTON
State : TX
Zip : 77008-2418
Country : US
Telephone Number : 713-864-2659
Fax Number : 888-592-4044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2010
Last Update Date : 02/14/2025

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Directions to “ ADAEZE AZWE AGBOR PA-C” Practice Location

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