Healthcare Provider Details

I. General information

NPI: 1679101174
Provider Name (Legal Business Name): JOHN E UKADIKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 UNIVERSITY BLVD
ROUND ROCK TX
78665-1032
US

IV. Provider business mailing address

300 UNIVERSITY BLVD
ROUND ROCK TX
78665-1032
US

V. Phone/Fax

Practice location:
  • Phone: 512-509-0100
  • Fax:
Mailing address:
  • Phone: 512-509-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2869
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberW3887
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: