Provider Demographics
NPI:1003007295
Name:UZOWULU, OBINNA C (MD)
Entity Type:Individual
Prefix:DR
First Name:OBINNA
Middle Name:C
Last Name:UZOWULU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 592228
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0161
Mailing Address - Country:US
Mailing Address - Phone:210-899-4490
Mailing Address - Fax:210-592-8195
Practice Address - Street 1:22250 BULVERDE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-3084
Practice Address - Country:US
Practice Address - Phone:210-899-4490
Practice Address - Fax:210-592-8195
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4641183775OtherMYUTMB 4641183775