Healthcare Provider Details

I. General information

NPI: 1164616199
Provider Name (Legal Business Name): DAVID OSAGIE OKUMBOR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID OSAGIE OKUMBOR M.D

II. Dates (important events)

Enumeration Date: 09/03/2007
Last Update Date: 04/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 N ROCKWALL AVE
TERRELL TX
75160-2117
US

IV. Provider business mailing address

18 KESTREL CT
HEATH TX
75032-2043
US

V. Phone/Fax

Practice location:
  • Phone: 972-522-8524
  • Fax:
Mailing address:
  • Phone: 214-675-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN1032
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: