Provider Demographics
NPI:1447297783
Name:AJIM, ALICE AMAH (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:AMAH
Last Name:AJIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALICE
Other - Middle Name:A
Other - Last Name:AJIMOTOKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3319 WILD RIVER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2488
Mailing Address - Country:US
Mailing Address - Phone:281-989-4586
Mailing Address - Fax:
Practice Address - Street 1:10900 GULF FWY STE B102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-2581
Practice Address - Country:US
Practice Address - Phone:713-946-7246
Practice Address - Fax:713-946-0243
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2080207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine