Provider Demographics
NPI:1295915452
Name:OPEKUN, ANTONE ROBERT JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANTONE
Middle Name:ROBERT
Last Name:OPEKUN
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3907 SPRING ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9314
Mailing Address - Country:US
Mailing Address - Phone:281-489-8325
Mailing Address - Fax:
Practice Address - Street 1:1 BAYLOR PLZ
Practice Address - Street 2:MEDICINE/PEDIATRICS MS620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:713-798-0956
Practice Address - Fax:713-798-0951
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant