Provider Demographics
NPI:1407295058
Name:OGUNBOR, ANDERSON OSAMUDIAMEN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ANDERSON
Middle Name:OSAMUDIAMEN
Last Name:OGUNBOR
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:STE 525
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3519
Mailing Address - Country:US
Mailing Address - Phone:713-661-7888
Mailing Address - Fax:
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:STE 525
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3519
Practice Address - Country:US
Practice Address - Phone:713-661-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX718102363LF0000X
TXAP123272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily