Basic Information
| Provider Information | |||||||||
| NPI: | 1376856039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKOTIE | ||||||||
| FirstName: | FIDELIS | ||||||||
| MiddleName: | AJOBOME | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4299 SAN FELIPE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770272916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8324763900 | ||||||||
| FaxNumber: | 8324766494 | ||||||||
| Practice Location | |||||||||
| Address1: | 2555 JIMMY JOHNSON BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | PORT ARTHUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776402007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098535086 | ||||||||
| FaxNumber: | 4098535084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2010 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2015-00495 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N8962 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD38814 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD.207776 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | N8962 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 0434428 | KS | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 2015-00495 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD.207776 | LA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 70415 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.