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NPI Code Detail

MEDICARE: DR. EBENEZER A NII-MOI M.D.

MEDICARE: DR. EBENEZER A NII-MOI M.D.
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
1207V00000XObstetrics & Gynecology PhysicianMD431796PA
2207V00000XObstetrics & Gynecology PhysicianQ8114TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18GK198OTHERTXBCBS TX
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396930376
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EBENEZER A NII-MOI M.D.
Provider Business Mailing Address
First Line : 1107 E MARSHALL AVE
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5602
Country : US
Telephone Number : 903-758-2610
Fax Number : 903-212-7689
Provider Business Practice Location Address
First Line : 705 E MARSHALL AVE STE 3000
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5661
Country : US
Telephone Number : 906-758-2610
Fax Number : 903-758-7081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2007
Last Update Date : 04/26/2024

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