Provider Demographics
NPI:1245550656
Name:BOGWU, JUSTIN IKEM (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:IKEM
Last Name:BOGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:713-338-5500
Practice Address - Street 1:14201 E SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6291
Practice Address - Country:US
Practice Address - Phone:281-812-4447
Practice Address - Fax:281-540-8748
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP7611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program