Provider Demographics
NPI:1326075524
Name:OKOSE, PETER CHUKWUEMEKA (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHUKWUEMEKA
Last Name:OKOSE
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 1:1007 COWARDS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4409
Mailing Address - Country:US
Mailing Address - Phone:832-606-9613
Mailing Address - Fax:713-330-1375
Practice Address - Street 1:151 CYPRESSWOOD DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-6038
Practice Address - Country:US
Practice Address - Phone:832-286-1664
Practice Address - Fax:832-826-1849
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084306201Medicaid
TX613174Medicare PIN
TX084306201Medicaid
TXE76147Medicare UPIN