Provider Demographics
NPI:1205016672
Name:O. E. EZEKOYE, MD, PA
Entity Type:Organization
Organization Name:O. E. EZEKOYE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFUNKE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-388-9711
Mailing Address - Street 1:1 CHISHOLM TRL
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5008
Mailing Address - Country:US
Mailing Address - Phone:512-388-9711
Mailing Address - Fax:
Practice Address - Street 1:1 CHISHOLM TRL
Practice Address - Street 2:SUITE 4100
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5008
Practice Address - Country:US
Practice Address - Phone:512-388-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care