Provider Demographics
NPI:1427300078
Name:REGENT CROSS MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:REGENT CROSS MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IKEDIEZE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-496-8410
Mailing Address - Street 1:1393 GEORGE DIETER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7410
Mailing Address - Country:US
Mailing Address - Phone:832-496-8410
Mailing Address - Fax:
Practice Address - Street 1:1393 GEORGE DIETER DR
Practice Address - Street 2:SUITE D
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7410
Practice Address - Country:US
Practice Address - Phone:915-996-9363
Practice Address - Fax:915-613-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty