MEDICARE: DR. STEPHEN OBIORAH MBAH

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	183500000X	Pharmacist	40307	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508193988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN OBIORAH MBAH

Provider Business Mailing Address
First Line	:	3165 KINGSWOOD CT
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7545
Country	:	US
Telephone Number	:	817-521-5144
Fax Number	:	682-518-5706

Provider Business Practice Location Address
First Line	:	15001 TRINITY BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76155-2647
Country	:	US
Telephone Number	:	817-685-0861
Fax Number	:	800-456-8966

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

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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