Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036.148440 | IL |
NPI | 1497002471 |
---|---|
Provider Name | Fortune Egbulefu |
First Address | Nellis Afb, NV 89191-6600 |
Second Address | Nellis Afb, NV 89191-6600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2012 |
Last Update Date | 14/04/2021 |