MEDICARE: DR. LAURETTA UFUOMA OGBUE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	350810210	OH
2	207R00000X	Internal Medicine Physician	M2737	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8X2743	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003807462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURETTA UFUOMA OGBUE MD

Provider Business Mailing Address
First Line	:	1717 MAIN ST
Second Line	:	SUITE 5200
City	:	DALLAS
State	:	TX
Zip	:	75201-4612
Country	:	US
Telephone Number	:	180-036-2273
Fax Number	:	214-712-2444

Provider Business Practice Location Address
First Line	:	1717 MAIN ST
Second Line	:	SUITE 5200
City	:	DALLAS
State	:	TX
Zip	:	75201-9815
Country	:	US
Telephone Number	:	180-036-2273
Fax Number	:	214-712-2444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	06/23/2011

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