Provider Demographics
NPI:1790274843
Name:UDOH, AGNES IKPOTO (MD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:IKPOTO
Last Name:UDOH
Suffix:
Gender:F
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:UTMB- PATHOLOGY DEPARTMENT 301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0428
Mailing Address - Country:US
Mailing Address - Phone:409-772-2870
Mailing Address - Fax:409-747-2400
Practice Address - Street 1:UTMB- PATHOLOGY DEPARTMENT 301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-2604
Practice Address - Country:US
Practice Address - Phone:409-772-2870
Practice Address - Fax:409-747-2400
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10080783207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology