Provider Demographics
NPI:1114540176
Name:OKAFOR, BENEDICT I SR
Entity Type:Individual
Prefix:MR
First Name:BENEDICT
Middle Name:I
Last Name:OKAFOR
Suffix:SR
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 1:9440 STRATTON DR APT 2304
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5334
Mailing Address - Country:US
Mailing Address - Phone:214-622-7903
Mailing Address - Fax:
Practice Address - Street 1:4645 AVON LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1301
Practice Address - Country:US
Practice Address - Phone:214-622-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX955425163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice