Provider Demographics
NPI:1891083689
Name:NWOJO, RAPHAEL EZERA (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:EZERA
Last Name:NWOJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-333-8808
Mailing Address - Fax:432-333-8136
Practice Address - Street 1:540 W 5TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5034
Practice Address - Country:US
Practice Address - Phone:432-333-8801
Practice Address - Fax:432-333-8136
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN16148207Y00000X
TXQ6353207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTRN16148OtherMEDICAL TRAINING LICENSE