Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 2288 | TX |
NPI | 1083029060 |
---|---|
Provider Name | Ejodamen Blessing Shobowale |
First Address | Houston, TX 77095-4375 |
Second Address | Houston, TX 77095-4379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2014 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003VAA | BCBS TX (01) | TX |
375642101 | (05) | TX |
375642102 | (05) | TX |
375642103 | (05) | TX |
375642104 | (05) | TX |
375642105 | (05) | TX |
375642106 | (05) | TX |
375642107 | (05) | TX |