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General NPI Number Information
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NPI Number | 1235467804
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Entity Type | Organization
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Legal Business Name | NOBLE EZUKANMA M.D P.A
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 117 KING RANCH CT
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City | FORT WORTH
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State | TX
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Zip | 76108-9593
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Country | US
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Telephone | 817-300-1471
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Fax |
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Provider Business Mailing Address
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Address Line | 117 KING RANCH CT
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City | FORT WORTH
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State | TX
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Zip | 76108-9593
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NOBLE U EZUKNAMA
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Credential | M.D.
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Telephone | 817-300-1471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | K8745
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License Number State | TX
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