Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | L7835 | TX |
N | 207RI0011X | Interventional Cardiology | L7835 | TX |
NPI | 1093704827 |
---|---|
Provider Name | Dr. Kenneth Ese Otah SR. |
First Address | Sugar Land, TX 77478-4083 |
Second Address | Sugar Land, TX 77478-4083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 06/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1754541 | (05) | TX |
I22396 | (02) |