| Doctor Name: | EJODAMEN BLESSING SHOBOWALE |
| NPI Number: | 1083029060 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | T66-2014 |
| Business Practice Address: | 22999 Highway 59 N #142 Kingwood, TX - 773394412 |
| Business Phone Number: | 2813488972 |
| Business Fax Number: | |
| Mailing Address: | 18814 Remington Mill Dr, HOUSTON |
| State: | TX |
| Postal Code: | 770734389 |
| Phone Number: | 7735100124 |
| Fax Number: | |
| NPI Enumeration Date: | 06/27/2014 |
| NPI Last Update Date: | 06/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | T66-2014 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |