Provider Demographics
NPI:1679589287
Name:UKPONG, EMEM D
Entity type:Individual
Prefix:
First Name:EMEM
Middle Name:D
Last Name:UKPONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 BLUEBONNET DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2911
Mailing Address - Country:US
Mailing Address - Phone:281-565-1731
Mailing Address - Fax:281-565-1732
Practice Address - Street 1:4240 BLUEBONNET DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2911
Practice Address - Country:US
Practice Address - Phone:281-565-1731
Practice Address - Fax:281-565-1732
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
8200358OtherDME
LA1622541Medicaid
8200358OtherDME