Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD000804 | GA |
Y | 222Z00000X | Podiatrist | POD000804 | GA |
NPI | 1053325480 |
---|---|
Provider Name | Dr. Evaristus Igbafe Oshiokpekhai |
First Address | Bonaire, GA 31005 |
Second Address | Warner Robins, GA 31093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U62334 | (02) | GA |