Provider Demographics
NPI:1689991408
Name:EKERUO, WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:EKERUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18300 KATY FWY
Mailing Address - Street 2:SUITE 325
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1385
Mailing Address - Country:US
Mailing Address - Phone:832-522-8300
Mailing Address - Fax:832-522-8301
Practice Address - Street 1:18300 KATY FWY
Practice Address - Street 2:SUITE 325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1385
Practice Address - Country:US
Practice Address - Phone:832-522-8300
Practice Address - Fax:832-522-8301
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5665208800000X
TXBP20023788208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1689991408OtherBLUE CROSS BLUE SHIELD
TX8CM009OtherBLUE CROSS BLUE SHIELD
TX280452801Medicaid
TX280452802Medicaid
TXP01062987OtherRAILROAD MEDICARE
TX280452803Medicaid
TX280452801Medicaid
TX1689991408OtherBLUE CROSS BLUE SHIELD
TXTXB152392Medicare PIN
TXTXB111082Medicare PIN
TX280452803Medicaid
TXTXB152393Medicare PIN