Provider Demographics
NPI:1104159888
Name:EKPE, CHARLES OFFIONG
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:OFFIONG
Last Name:EKPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 BISSELL WAY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5916
Mailing Address - Country:US
Mailing Address - Phone:469-258-3179
Mailing Address - Fax:972-442-7641
Practice Address - Street 1:2703 BISSELL WAY
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5916
Practice Address - Country:US
Practice Address - Phone:469-258-3179
Practice Address - Fax:972-442-7641
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist