Healthcare Provider Details

I. General information

NPI: 1124066634
Provider Name (Legal Business Name): CHIJIOKE DAVID UKOHA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N GALLOWAY AVE
MESQUITE TX
75149-2258
US

IV. Provider business mailing address

306 STONEMEADE WAY
COPPELL TX
75019-2679
US

V. Phone/Fax

Practice location:
  • Phone: 972-279-1700
  • Fax: 972-279-1102
Mailing address:
  • Phone: 972-279-1700
  • Fax: 972-279-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ8405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: