Provider Demographics
NPI:1992369151
Name:OKOTIE-EBOH, ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:OKOTIE-EBOH
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 1:1431 STUDEMONT ST STE C2400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3803
Mailing Address - Country:US
Mailing Address - Phone:713-242-2980
Mailing Address - Fax:713-862-5400
Practice Address - Street 1:1431 STUDEMONT ST STE C2400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3803
Practice Address - Country:US
Practice Address - Phone:713-242-2980
Practice Address - Fax:713-862-5400
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT8906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204923281OtherTAX ID