Provider Demographics
NPI:1205670387
Name:OBANOR, OSAMUDIAMEN JOSEPH
Entity type:Individual
Prefix:
First Name:OSAMUDIAMEN
Middle Name:JOSEPH
Last Name:OBANOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 FAIRBREEZE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5103
Mailing Address - Country:US
Mailing Address - Phone:832-392-1786
Mailing Address - Fax:832-392-1786
Practice Address - Street 1:4218 BRANNON BRANCH CT
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1543
Practice Address - Country:US
Practice Address - Phone:832-392-1786
Practice Address - Fax:832-437-7341
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149759372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider