Provider Demographics
NPI:1104900067
Name:FIRST FRUITS MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:FIRST FRUITS MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:OKPALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-358-8982
Mailing Address - Street 1:1211 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5207
Mailing Address - Country:US
Mailing Address - Phone:361-358-8982
Mailing Address - Fax:361-358-2176
Practice Address - Street 1:1211 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5207
Practice Address - Country:US
Practice Address - Phone:361-358-8982
Practice Address - Fax:361-358-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty