Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | K7853 | TX |
NPI | 1033268628 |
---|---|
Provider Name | Dr. Charles O Orji |
First Address | Tyler, TX 75701-2130 |
Second Address | Tyler, TX 75701-2130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 29/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165663901 | (05) | TX |
200214970 A | (05) | OK |
H88841 | (02) | |
P00270940 | RAILROAD MEDICARE (01) |