Provider Demographics
NPI:1619177383
Name:OGIAMIEN, PETER IDEMUDIA
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:IDEMUDIA
Last Name:OGIAMIEN
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 1:6201 BONHOMME RD
Mailing Address - Street 2:SUITE 290 N- I
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4365
Mailing Address - Country:US
Mailing Address - Phone:713-783-2070
Mailing Address - Fax:713-783-2070
Practice Address - Street 1:6201 BONHOMME RD
Practice Address - Street 2:SUITE 290 N- I
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4365
Practice Address - Country:US
Practice Address - Phone:713-783-2070
Practice Address - Fax:713-783-2070
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5991360001Medicare NSC