MEDICARE: MR. ENARUNA CHRISTOPHER OGBEIDE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA05843	TX

General Provider Information

NPI Number	:	1417380890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ENARUNA CHRISTOPHER OGBEIDE PA-C

Provider Business Mailing Address
First Line	:	122 W JOHN CARPENTER FWY STE 420
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2014
Country	:	US
Telephone Number	:	972-957-3000
Fax Number	:	972-957-3005

Provider Business Practice Location Address
First Line	:	5402 AIRLINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-4902
Country	:	US
Telephone Number	:	713-239-1572
Fax Number	:	713-239-1577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	03/07/2023

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