Individual
KOFOWOROLA MARIAM KUBOYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
2810 W 1ST ST STE 30, PROSPER, TX 75078-8151
(469) 281-2388
Mailing address
2810 W 1ST ST STE 30, PROSPER, TX 75078-8151
(469) 281-2388
(940) 323-0553
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
Q6050
TX
2080A0000X
Pediatric Adolescent Medicine Physician
21756
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/15/2008
Last updated
09/11/2024
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