Healthcare Provider Details

I. General information

NPI: 1821174368
Provider Name (Legal Business Name): ANIRE OKPAKU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BRIDGE POINT PKWY STE 150
AUSTIN TX
78730-5117
US

IV. Provider business mailing address

6200 BRIDGE POINT PKWY STE 150
AUSTIN TX
78730-5117
US

V. Phone/Fax

Practice location:
  • Phone: 737-249-9341
  • Fax: 737-309-2813
Mailing address:
  • Phone: 737-249-9341
  • Fax: 737-309-2813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME95013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: