Provider Demographics
NPI:1891352472
Name:OKOTIE-EBOH, OMARE S (MD)
Entity Type:Individual
Prefix:DR
First Name:OMARE
Middle Name:S
Last Name:OKOTIE-EBOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 NORTH LOOP W STE 30
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1445
Mailing Address - Country:US
Mailing Address - Phone:713-802-9781
Mailing Address - Fax:713-868-2193
Practice Address - Street 1:1801 NORTH LOOP W STE 30
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1445
Practice Address - Country:US
Practice Address - Phone:713-802-9781
Practice Address - Fax:713-868-2193
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU6044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine