Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | R1096 | TX |
NPI | 1306008180 |
---|---|
Provider Name | Ikechukwu Ifeanyi Onyedika |
First Address | El Paso, TX 79912-6104 |
Second Address | El Paso, TX 79912-6104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 17/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R1096 | TEXAS MEDICAL LICENSE (01) | TX |