MEDICARE: DR. EBERE I AZUBUIKE 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	207Q00000X	Family Medicine Physician	M9136	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M9136	OTHER	TX	LICENCE

General Provider Information

NPI Number	:	1275738874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EBERE I AZUBUIKE MD

Provider Business Mailing Address
First Line	:	501 WYNNEWOOD VILLAGE
Second Line	:	SUITE 102A
City	:	DALLAS
State	:	TX
Zip	:	75224
Country	:	US
Telephone Number	:	214-942-2377
Fax Number	:	214-942-2977

Provider Business Practice Location Address
First Line	:	501 WYNNEWOOD VILLAGE
Second Line	:	SUITE 102A
City	:	DALLAS
State	:	TX
Zip	:	75224-1838
Country	:	US
Telephone Number	:	214-942-2377
Fax Number	:	214-942-2977

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	05/07/2015

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