Provider Demographics
NPI:1366070211
Name:FAGBEMI, STELLA O (MD)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:O
Last Name:FAGBEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 TAUB LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1608
Mailing Address - Country:US
Mailing Address - Phone:173-798-1000
Mailing Address - Fax:
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:173-798-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU3513207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program