Provider Demographics
NPI:1164534426
Name:OSAGIE, OWEN O (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:O
Last Name:OSAGIE
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 1:4910 AIRPORT AVE
Mailing Address - Street 2:BLDG D
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5759
Mailing Address - Country:US
Mailing Address - Phone:281-239-1384
Mailing Address - Fax:281-239-0828
Practice Address - Street 1:4910 AIRPORT AVE
Practice Address - Street 2:BLDG A
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5759
Practice Address - Country:US
Practice Address - Phone:281-239-1384
Practice Address - Fax:281-239-0828
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK09712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046225101Medicaid
TX87Y952Medicare ID - Type UnspecifiedPROVIDER #
TXG31359Medicare UPIN