Healthcare Provider Details

I. General information

NPI: 1467651604
Provider Name (Legal Business Name): MR. JOSEPH M. OKORO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 BLUFF BEND DR
AUSTIN TX
78753-4301
US

IV. Provider business mailing address

PO BOX 15991
AUSTIN TX
78761-5991
US

V. Phone/Fax

Practice location:
  • Phone: 512-785-3124
  • Fax:
Mailing address:
  • Phone: 512-785-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA8460907
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: