Healthcare Provider Details

I. General information

NPI: 1679990360
Provider Name (Legal Business Name): NGOZI OKOBA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NGOZICHUKWUKA OKOBA M.D

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 N EXPRESSWAY 77
OLMITO TX
78575-5171
US

IV. Provider business mailing address

PO BOX 412880
BOSTON MA
02241-2880
US

V. Phone/Fax

Practice location:
  • Phone: 956-982-4484
  • Fax: 956-982-4489
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberS103
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: