Provider Demographics
NPI:1831654045
Name:RAPHAEL E NWOJO MD PA
Entity Type:Organization
Organization Name:RAPHAEL E NWOJO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:EZERA
Authorized Official - Last Name:NWOJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-640-6360
Mailing Address - Street 1:PO BOX 3146
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-3146
Mailing Address - Country:US
Mailing Address - Phone:432-640-6360
Mailing Address - Fax:432-640-4759
Practice Address - Street 1:540 W 5TH ST STE 410
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5067
Practice Address - Country:US
Practice Address - Phone:432-640-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty