Healthcare Provider Details

I. General information

NPI: 1033642806
Provider Name (Legal Business Name): EMMANUEL C OHUABUNWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 HARRY HINES BLVD
DALLAS TX
75390-1361
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-8579
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3916
  • Fax:
Mailing address:
  • Phone: 713-933-5163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS9367
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: