1205084316 NPI number — DR. CHINYERE ODU MD

Table of content: DR. CHINYERE ODU MD (NPI 1205084316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205084316 NPI number — DR. CHINYERE ODU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODU
Provider First Name:
CHINYERE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205084316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1045 CENTRAL PARKWAY NORTH
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232-5024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-541-4500
Provider Business Mailing Address Fax Number:
210-541-4508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 NW MILITARY HWY
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78213-1859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-696-2264
Provider Business Practice Location Address Fax Number:
210-340-5276
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  N8330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N8330 . This is a "TX LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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