Healthcare Provider Details

I. General information

NPI: 1609987601
Provider Name (Legal Business Name): NWOSU OSARO NGOFA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 LAKEWOOD DR STE A
MORGAN CITY LA
70380-1866
US

IV. Provider business mailing address

1300 LAKEWOOD DR STE A P.O. BOX 1898
MORGAN CITY LA
70380-1866
US

V. Phone/Fax

Practice location:
  • Phone: 985-519-6744
  • Fax: 985-384-0899
Mailing address:
  • Phone: 985-519-6744
  • Fax: 985-384-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM3821
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.201984
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: