Provider Demographics
NPI:1528276920
Name:UKEGBU, OKEZIE ONYEBUENYI (PA; DC)
Entity type:Individual
Prefix:DR
First Name:OKEZIE
Middle Name:ONYEBUENYI
Last Name:UKEGBU
Suffix:
Gender:M
Credentials:PA; DC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10906 SAGECREST LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-3902
Mailing Address - Country:US
Mailing Address - Phone:832-891-5868
Mailing Address - Fax:
Practice Address - Street 1:630 MURPHY RD STE 112
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5928
Practice Address - Country:US
Practice Address - Phone:281-552-8898
Practice Address - Fax:281-978-2690
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02248363AS0400X
TX9911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP12563Medicare UPIN