Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 286049 | NY |
N | 207RG0100X | Gastroenterologist | D0046334 | MD |
NPI | 1003835299 |
---|---|
Provider Name | Dr. Patrick Ikemefuna Okolo III |
First Address | Rochester, NY 14617-5504 |
Second Address | Rochester, NY 14621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 14/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162371100 | (05) | MD |
F34651 | (02) |