Healthcare Provider Details

I. General information

NPI: 1154708022
Provider Name (Legal Business Name): NZUBE C OKONKWO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17070 RED OAK DR STE 403
HOUSTON TX
77090-2609
US

IV. Provider business mailing address

17070 RED OAK DR STE 403
HOUSTON TX
77090-2609
US

V. Phone/Fax

Practice location:
  • Phone: 281-836-5691
  • Fax: 281-836-5692
Mailing address:
  • Phone: 281-836-5691
  • Fax: 281-836-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35061
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberT4811
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62790
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: