Provider Demographics
NPI:1164616199
Name:OKUMBOR, DAVID OSAGIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:OSAGIE
Last Name:OKUMBOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:OSAGIE
Other - Last Name:OKUMBOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:18 KESTREL CT
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2043
Mailing Address - Country:US
Mailing Address - Phone:214-675-3859
Mailing Address - Fax:
Practice Address - Street 1:604 N ROCKWALL AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2117
Practice Address - Country:US
Practice Address - Phone:972-522-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine