Healthcare Provider Details

I. General information

NPI: 1053348664
Provider Name (Legal Business Name): OBI FRANCIS OKONKWO-ONUIGBO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 WEST BAY DRIVE SUITE H
LARGO FL
33770
US

IV. Provider business mailing address

1258 WEST BAY DRIVE SUITE H
LARGO FL
33770
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-3313
  • Fax: 727-584-3315
Mailing address:
  • Phone: 727-584-3313
  • Fax: 727-584-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME83217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: