Provider Demographics
NPI:1386793131
Name:OKEKE, ERNEST T (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:T
Last Name:OKEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 J. L.CHESTNUT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701
Mailing Address - Country:US
Mailing Address - Phone:334-875-9472
Mailing Address - Fax:334-872-4665
Practice Address - Street 1:901 JEFF DAVIS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701
Practice Address - Country:US
Practice Address - Phone:334-875-9472
Practice Address - Fax:334-872-4665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010696Medicaid
AL51010696OtherBCBS OF ALABAMA
C78774Medicare UPIN
AL000010696Medicare ID - Type Unspecified