Healthcare Provider Details

I. General information

NPI: 1437109220
Provider Name (Legal Business Name): COMPLETE FAMILY PRACTICE & SPORTS MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N BUCKNER BLVD SUITE 405
DALLAS TX
75218-3426
US

IV. Provider business mailing address

1151 N BUCKNER BLVD SUITE 405
DALLAS TX
75218-3426
US

V. Phone/Fax

Practice location:
  • Phone: 214-319-2900
  • Fax:
Mailing address:
  • Phone: 214-319-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. OBINNA U CHUKWUOCHA
Title or Position: MEDICAL DIRECTOR/PRESIDENT
Credential: D.O.
Phone: 214-319-2900