Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1044623 | TX |
NPI | 1053070284 |
---|---|
Provider Name | Thompson Ugoh |
First Address | Dallas, TX 75243-6238 |
Second Address | Dallas, TX 75243-6238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2021 |
Last Update Date | 15/12/2021 |