Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 350810210 | OH |
N | 111NI0900X | Internist | 350810210 | OH |
Y | 207R00000X | Internist | M2737 | TX |
Y | 111NI0900X | Internist | M2737 | TX |
NPI | 1003807462 |
---|---|
Provider Name | Dr. Lauretta Ufuoma Ogbue |
First Address | Dallas, TX 75201-4612 |
Second Address | Dallas, TX 75201-9815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 23/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
186042101 | (05) | TX |
2333148 | (05) | OH |
8X2743 | BCBS (01) | TX |
H61310 | (02) |