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General NPI Number Information
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NPI Number | 1487974630
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Entity Type | Individual
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Provider Name | ETAGBO OQUA ETA M.D
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Gender | Male
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Dates
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Enumeration Date | 06/09/2010
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 311 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5212
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Country | US
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Telephone | 256-543-0989
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7190
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City | RAINBOW CITY
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State | AL
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Zip | 35906-7190
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Country | US
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Telephone | 256-203-4713
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD.35051
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD.35051
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License Number State | AL
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