Healthcare Provider Details

I. General information

NPI: 1497117253
Provider Name (Legal Business Name): JOSEPH OKECHUKWU OBI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1886 59TH ST W
BRADENTON FL
34209-4630
US

IV. Provider business mailing address

1886 59TH ST W
BRADENTON FL
34209-4630
US

V. Phone/Fax

Practice location:
  • Phone: 941-794-1980
  • Fax: 941-794-2893
Mailing address:
  • Phone: 941-794-1980
  • Fax: 941-794-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME139222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: