Healthcare Provider Details

I. General information

NPI: 1285696757
Provider Name (Legal Business Name): JOHN WILLIAM UFEMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 EAST VILLA MARIA ROAD #204
BRYAN TX
77802
US

IV. Provider business mailing address

PO BOX 7017
BRYAN TX
77805
US

V. Phone/Fax

Practice location:
  • Phone: 979-690-6869
  • Fax:
Mailing address:
  • Phone: 979-690-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberJ7238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: