Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | L9145 | TX |
NPI | 1316997455 |
---|---|
Provider Name | Dr. Obinna Chukwuocha |
First Address | Plano, TX 75093-4852 |
Second Address | Plano, TX 75093-4852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 30/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I17072 | (02) | TX |