Provider Demographics
NPI:1164656633
Name:AGBETOBA, ABIB (MD)
Entity Type:Individual
Prefix:
First Name:ABIB
Middle Name:
Last Name:AGBETOBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10740 N GESSNER RD
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:STE 1800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2934
Practice Address - Country:US
Practice Address - Phone:713-791-9363
Practice Address - Fax:713-795-0488
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9502207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX354136YMNBMedicare PIN