Provider Demographics
NPI:1073966222
Name:OVIAWE, OSAZEE (MD)
Entity Type:Individual
Prefix:
First Name:OSAZEE
Middle Name:
Last Name:OVIAWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 N MAJOR DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-9034
Mailing Address - Country:US
Mailing Address - Phone:098-922-2624
Mailing Address - Fax:409-892-3336
Practice Address - Street 1:5875 N MAJOR DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-9034
Practice Address - Country:US
Practice Address - Phone:409-892-2262
Practice Address - Fax:409-892-3336
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-069698390200000X
TXS5458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program