Provider Demographics
NPI:1679808810
Name:AGBOGWE, SUNDAY
Entity Type:Individual
Prefix:
First Name:SUNDAY
Middle Name:
Last Name:AGBOGWE
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 1:3411 FONDREN RD
Mailing Address - Street 2:B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5652
Mailing Address - Country:US
Mailing Address - Phone:713-974-1122
Mailing Address - Fax:713-974-1125
Practice Address - Street 1:3411 FONDREN RD
Practice Address - Street 2:B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5652
Practice Address - Country:US
Practice Address - Phone:713-974-1122
Practice Address - Fax:713-974-1125
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000107332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies