Healthcare Provider Details

I. General information

NPI: 1265708580
Provider Name (Legal Business Name): CHUKWUJEKWU OKPALAJI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 09/23/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SAN ELIZARIO RD STE H
CLINT TX
79836-6739
US

IV. Provider business mailing address

PO BOX 657
CLINT TX
79836-0657
US

V. Phone/Fax

Practice location:
  • Phone: 915-209-3722
  • Fax: 915-703-2208
Mailing address:
  • Phone: 915-209-3722
  • Fax: 915-703-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ2172
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: