Provider Demographics
NPI:1336275130
Name:SARPONG, KWAME (PA,)
Entity type:Individual
Prefix:
First Name:KWAME
Middle Name:
Last Name:SARPONG
Suffix:
Gender:M
Credentials:PA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 HOLLY OAK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3116
Mailing Address - Country:US
Mailing Address - Phone:281-631-9433
Mailing Address - Fax:
Practice Address - Street 1:8200 WEDNESBURY LN
Practice Address - Street 2:SUITE 360
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2925
Practice Address - Country:US
Practice Address - Phone:713-484-6200
Practice Address - Fax:713-773-0905
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03291363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C8988Medicare ID - Type Unspecified
TXP62643Medicare UPIN