Provider Demographics
NPI:1457055733
Name:KOUAM, JOHN-STEPHANE SHOUMOU (MD)
Entity Type:Individual
Prefix:
First Name:JOHN-STEPHANE
Middle Name:SHOUMOU
Last Name:KOUAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-6415
Mailing Address - Country:US
Mailing Address - Phone:682-554-1974
Mailing Address - Fax:
Practice Address - Street 1:6363 FOREST PARK RD FL 27
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5479
Practice Address - Country:US
Practice Address - Phone:214-648-7312
Practice Address - Fax:214-648-7370
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program