MEDICARE: ALFRED LOUIS AND EMMANUEL AGOH LLC

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
1	208D00000X	General Practice Physician		TX

General Provider Information

NPI Number	:	1255671095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALFRED LOUIS AND EMMANUEL AGOH LLC

Provider Business Mailing Address
First Line	:	8109 CULLEN BLVD
Second Line	:	E
City	:	HOUSTON
State	:	TX
Zip	:	77051-2064
Country	:	US
Telephone Number	:	713-734-1697
Fax Number	:	713-733-9316

Provider Business Practice Location Address
First Line	:	8109 CULLEN BLVD
Second Line	:	C
City	:	HOUSTON
State	:	TX
Zip	:	77051-2064
Country	:	US
Telephone Number	:	713-734-1697
Fax Number	:	713-733-9316

Authorized Official
Title or Position	:	OWNER
Name	:	ALFRED LOUIS
Credential	:	MD
Telephone Number	:	713-734-1697

Provider Enumeration Date	:	02/14/2013
Last Update Date	:	02/14/2013

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