1316110604 NPI number — VICTOR MORDECAI AWUOR DO

Table of content: VICTOR MORDECAI AWUOR DO (NPI 1316110604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316110604 NPI number — VICTOR MORDECAI AWUOR DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AWUOR
Provider First Name:
VICTOR
Provider Middle Name:
MORDECAI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1316110604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 FRANTZ RD
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43016-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-544-6210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 REFUGEE RD
Provider Second Line Business Practice Location Address:
STE 310
Provider Business Practice Location Address City Name:
PICKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147-9653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-533-5500
Provider Business Practice Location Address Fax Number:
614-566-9777
Provider Enumeration Date:
04/08/2008

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: 207T00000X , with the licence number:  34009836 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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