Provider Demographics
NPI:1851595698
Name:EJERE, HENRY OMOIKHUDU DIMMA (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:OMOIKHUDU DIMMA
Last Name:EJERE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:730 EUREKA ST
Mailing Address - Street 2:C/O HENRY EJERE, MD
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6546
Mailing Address - Country:US
Mailing Address - Phone:682-582-2989
Mailing Address - Fax:682-268-2137
Practice Address - Street 1:730 EUREKA ST
Practice Address - Street 2:C/O HENRY EJERE, MD
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6546
Practice Address - Country:US
Practice Address - Phone:325-642-8315
Practice Address - Fax:817-596-7008
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-03-04
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Provider Licenses
StateLicense IDTaxonomies
TXN5664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107960Medicare PIN