Provider Demographics
NPI:1003871658
Name:OKPON ONABAJO, CATHERINE ENO (MD,)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ENO
Last Name:OKPON ONABAJO
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:STEPHEN ENO
Other - Last Name:OKPON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:125 KINGSRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2574
Mailing Address - Country:US
Mailing Address - Phone:972-745-7072
Mailing Address - Fax:972-745-3181
Practice Address - Street 1:1118 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3426
Practice Address - Country:US
Practice Address - Phone:972-956-5558
Practice Address - Fax:972-956-0578
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-12253207P00000X
TXK1890207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176341902Medicaid
TX137971121Medicaid
TX8U0990OtherBLUE SHIELD
TX137971121Medicaid
TX8F0984Medicare PIN