MEDICARE: ENYIBUAKU RITA UZOAGA

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	111N00000X	Chiropractor	6779	TX
2	111NN0400X	Neurology Chiropractor	6779	TX
3	111NR0400X	Rehabilitation Chiropractor	6779	TX
4	207Q00000X	Family Medicine Physician	M0297	TX
5	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	M0297	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0057RP	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1598929432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENYIBUAKU RITA UZOAGA

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	INGRAM
State	:	TX
Zip	:	78025-0550
Country	:	US
Telephone Number	:	713-772-5669
Fax Number	:	713-772-5536

Provider Business Practice Location Address
First Line	:	9119 S GESSNER DR
Second Line	:	SUITE 305
City	:	HOUSTON
State	:	TX
Zip	:	77074-2874
Country	:	US
Telephone Number	:	713-772-5669
Fax Number	:	713-772-5536

Authorized Official
Title or Position	:	OWNER PROVIDER
Name	:	DR. ENYIBUAKU RITA UZOAGA
Credential	:	MD
Telephone Number	:	713-772-5669

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	08/04/2008

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Directions to “ENYIBUAKU RITA UZOAGA ” Practice Location

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