Provider Demographics
NPI:1033448006
Name:ONWUGAMBA, JERRY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:ONWUGAMBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MURPHY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5927
Mailing Address - Country:US
Mailing Address - Phone:281-748-8357
Mailing Address - Fax:
Practice Address - Street 1:620 MURPHY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5927
Practice Address - Country:US
Practice Address - Phone:281-748-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport