MEDICARE: DR. CHIZOBA C. OBI 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	207RN0300X	Nephrology Physician	P9423	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00985983	OTHER	MO	RAILROAD MEDICARE
3	1J4970	OTHER	TX	MEDICARE
8	P02596718	OTHER	TX	RR MEDICARE

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
4	431560263	OTHER	MO	TRICARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	P00985983	OTHER	MO	RR MCR
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376708222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHIZOBA C. OBI MD

Provider Business Mailing Address
First Line	:	2310 DE LEE ST STE 100
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-485-9496
Fax Number	:	979-485-9497

Provider Business Practice Location Address
First Line	:	2310 DE LEE ST STE 100
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-485-9496
Fax Number	:	979-485-9497

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	07/23/2023

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Directions to “ DR. CHIZOBA C. OBI MD” Practice Location

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