Provider Demographics
NPI:1659557551
Name:AGBASI, FUNKE F (MD)
Entity Type:Individual
Prefix:
First Name:FUNKE
Middle Name:F
Last Name:AGBASI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUFUNKE
Other - Middle Name:F
Other - Last Name:FADIPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12345 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1503
Mailing Address - Country:US
Mailing Address - Phone:281-679-5600
Mailing Address - Fax:
Practice Address - Street 1:12345 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1503
Practice Address - Country:US
Practice Address - Phone:281-679-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine