Provider Demographics
NPI:1689755985
Name:ADU-GYAMFI, KWAME (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:KWAME
Middle Name:
Last Name:ADU-GYAMFI
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25149 RAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-6365
Mailing Address - Country:US
Mailing Address - Phone:281-354-7074
Mailing Address - Fax:
Practice Address - Street 1:8518 JENSEN DRIVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093
Practice Address - Country:US
Practice Address - Phone:713-691-2112
Practice Address - Fax:713-691-1771
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 03713363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D1068419OtherCLIA ID NUMBER
TX8Y3148OtherBCBS
TX184797202Medicaid
TX184797201Medicaid
TX184798001Medicaid
TX1356490882OtherNPI
TXPA 03713OtherTEXAS MEDICAL BOARD OF PH
TX1055703OtherNCCPA
TX1055703OtherNCCPA
TX8Y3148OtherBCBS
Q75527Medicare UPIN
8F4272Medicare PIN
00X195Medicare PIN