Healthcare Provider Details

I. General information

NPI: 1215949144
Provider Name (Legal Business Name): OKEY OKOLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13035 NACOGDOCHES RD
SAN ANTONIO TX
78217-1960
US

IV. Provider business mailing address

14100 NACOGDOCHES RD SUITE 140
SAN ANTONIO TX
78247-1903
US

V. Phone/Fax

Practice location:
  • Phone: 210-333-8895
  • Fax: 210-599-3693
Mailing address:
  • Phone: 210-333-8895
  • Fax: 210-599-3693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL1418
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: