MEDICARE: GABRIEL U. OGBONNAYA M.D.

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	207R00000X	Internal Medicine Physician	32142	AZ

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	:	1972502862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL U. OGBONNAYA M.D.

Provider Business Mailing Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	SUITE # 124
City	:	MESA
State	:	AZ
Zip	:	85212-2164
Country	:	US
Telephone Number	:	480-361-3636
Fax Number	:	480-361-2525

Provider Business Practice Location Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	SUITE # 124
City	:	MESA
State	:	AZ
Zip	:	85212-2164
Country	:	US
Telephone Number	:	480-361-3636
Fax Number	:	480-361-2525

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/25/2008

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