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Individual

EGUONO EJAYERIESE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
400 HARBORSIDE DR, GALVESTON, TX 77550
(409) 772-2166
Mailing address
PO BOX 650859, DALLAS, TX 75265-0859

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
BP10089862
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
BP10089862
TX LICENSE
TX
Enumeration date
06/18/2024
Last updated
06/18/2024
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