Provider Demographics
NPI:1679990360
Name:OKOBA, NGOZI (MD)
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:
Last Name:OKOBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NGOZICHUKWUKA
Other - Middle Name:
Other - Last Name:OKOBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:942 WILDROSE LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8817
Mailing Address - Country:US
Mailing Address - Phone:240-837-3293
Mailing Address - Fax:
Practice Address - Street 1:942 WILDROSE LN
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8817
Practice Address - Country:US
Practice Address - Phone:240-837-3293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS103207RN0300X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology