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General NPI Number Information
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NPI Number | 1417477613
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Entity Type | Individual
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Provider Name | ANTHONY IKENNA OKAFOR
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Gender | Male
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 11212 STATE HIGHWAY 151 SUITE 105-MEDICAL PLAZA II
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City | SAN ANTONIO
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State | TX
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Zip | 78251
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Country | US
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Telephone | 210-309-1405
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Fax | 210-477-5224
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Provider Business Mailing Address
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Address Line | 12317 ABBEY GDN
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2791
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Country | US
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Telephone | 512-659-5086
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA11284
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License Number State | TX
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