Healthcare Provider Details

I. General information

NPI: 1356633846
Provider Name (Legal Business Name): MARY IJEOMA UKOR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 BOONE RD
HOUSTON TX
77099-1659
US

IV. Provider business mailing address

8901 BOONE RD
HOUSTON TX
77099-1659
US

V. Phone/Fax

Practice location:
  • Phone: 814-540-5002
  • Fax: 281-454-0516
Mailing address:
  • Phone: 281-454-0500
  • Fax: 281-454-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP9477
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: