Provider Demographics
NPI:1841494028
Name:OBOKHARE, JOY (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:OBOKHARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:FALOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:806-398-3627
Mailing Address - Fax:
Practice Address - Street 1:3501 S SONCY RD STE 104
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-398-3627
Practice Address - Fax:806-351-7801
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1909207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2896219-03Medicaid
TX2896219-03Medicaid