Healthcare Provider Details

I. General information

NPI: 1639126501
Provider Name (Legal Business Name): HENRY U OGBOGU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W PLEASANT RUN RD SUITE 200
LANCASTER TX
75146-1079
US

IV. Provider business mailing address

609 SAINT JAMES PL
COPPELL TX
75019-2751
US

V. Phone/Fax

Practice location:
  • Phone: 972-230-8881
  • Fax: 972-230-8810
Mailing address:
  • Phone: 214-587-4043
  • Fax: 972-304-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ8077
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberJ8077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: