Healthcare Provider Details

I. General information

NPI: 1104207323
Provider Name (Legal Business Name): IFEANYI DAVID NWOKEABIA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N STE 2110
ALLEN TX
75013-6122
US

IV. Provider business mailing address

660 S EUCLID AVE CAMPUS BOX 8054
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 469-251-8488
  • Fax:
Mailing address:
  • Phone: 314-362-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberS8086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: