Healthcare Provider Details

I. General information

NPI: 1235517087
Provider Name (Legal Business Name): IFEOMA TAMARA OGBONNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W WHEATLAND RD STE 140
DUNCANVILLE TX
75116-4628
US

IV. Provider business mailing address

532 SIMS DR
CEDAR HILL TX
75104-7711
US

V. Phone/Fax

Practice location:
  • Phone: 972-503-4109
  • Fax:
Mailing address:
  • Phone: 469-777-0778
  • Fax: 615-327-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number56886
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberS0347
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS0347
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: