Provider Demographics
NPI:1235382292
Name:UDOFIA, FRIDAY
Entity Type:Individual
Prefix:
First Name:FRIDAY
Middle Name:
Last Name:UDOFIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 WESTPARK DR
Mailing Address - Street 2:STE 450
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5138
Mailing Address - Country:US
Mailing Address - Phone:713-339-9898
Mailing Address - Fax:
Practice Address - Street 1:9950 WESTPARK DR
Practice Address - Street 2:STE 450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5138
Practice Address - Country:US
Practice Address - Phone:713-339-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX423450332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
6327860001Medicare NSC