Healthcare Provider Details

I. General information

NPI: 1760596563
Provider Name (Legal Business Name): JOHN OKECHUKWU NWORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 WARD AVE
CARUTHERSVILLE MO
63830-2622
US

IV. Provider business mailing address

PO BOX 200 1117 WARD AVE
CARUTHERSVILLE MO
63830-0200
US

V. Phone/Fax

Practice location:
  • Phone: 573-333-4441
  • Fax: 573-333-5142
Mailing address:
  • Phone: 573-333-4441
  • Fax: 573-333-5142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number106331
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: