Healthcare Provider Details

I. General information

NPI: 1790701415
Provider Name (Legal Business Name): FRANCIS C OGBONNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 BEECHWOOD LN
CEDAR HILL TX
75104-2977
US

IV. Provider business mailing address

332 BEECHWOOD LN
CEDAR HILL TX
75104-2977
US

V. Phone/Fax

Practice location:
  • Phone: 972-322-0048
  • Fax: 972-298-2909
Mailing address:
  • Phone: 972-322-0048
  • Fax: 972-298-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License NumberR28642
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: