Provider Demographics
NPI:1134397821
Name:SOFOWORA, GABRIEL T
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:T
Last Name:SOFOWORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 HILLCROFT ST
Mailing Address - Street 2:STE. 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4888
Mailing Address - Country:US
Mailing Address - Phone:713-270-1900
Mailing Address - Fax:713-270-1902
Practice Address - Street 1:6601 HILLCROFT ST
Practice Address - Street 2:STE. 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4888
Practice Address - Country:US
Practice Address - Phone:713-270-1900
Practice Address - Fax:713-270-1902
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0100567332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6208730001Medicare NSC