Healthcare Provider Details

I. General information

NPI: 1497830798
Provider Name (Legal Business Name): GODWIN E OKOJIE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 BRYAN ST SUITE 500
DALLAS TX
75204-8300
US

IV. Provider business mailing address

4101 ROSS AVE SUITE 500
DALLAS TX
75204-5138
US

V. Phone/Fax

Practice location:
  • Phone: 214-515-9646
  • Fax:
Mailing address:
  • Phone: 214-515-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011499
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 18648
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA05751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: