Provider Demographics
NPI:1982635876
Name:IDJAGBORO, DAMIAN OKPAKO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:OKPAKO
Last Name:IDJAGBORO
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 1950
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-1950
Mailing Address - Country:US
Mailing Address - Phone:956-536-1403
Mailing Address - Fax:956-361-4539
Practice Address - Street 1:8449 W BELLFORT ST
Practice Address - Street 2:SUTIE 245
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2245
Practice Address - Country:US
Practice Address - Phone:832-366-5980
Practice Address - Fax:713-900-6807
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA03357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant