Provider Demographics
NPI:1093180077
Name:JOHN OKEREKE MD PA
Entity Type:Organization
Organization Name:JOHN OKEREKE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OKEZIKA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OKEREKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-399-2920
Mailing Address - Street 1:PO BOX 4680
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-4680
Mailing Address - Country:US
Mailing Address - Phone:956-399-2920
Mailing Address - Fax:956-399-2940
Practice Address - Street 1:1000 N DICK DOWLING ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-5222
Practice Address - Country:US
Practice Address - Phone:956-399-2920
Practice Address - Fax:956-399-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1599208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113307602Medicaid
TX113307602Medicaid