Provider Demographics
NPI:1235467804
Name:NOBLE EZUKANMA M.D P.A
Entity Type:Organization
Organization Name:NOBLE EZUKANMA M.D P.A
Other - Org Name:NOBILITY PULMONARY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:U
Authorized Official - Last Name:EZUKNAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-300-1471
Mailing Address - Street 1:117 KING RANCH CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-9593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 KING RANCH CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-9593
Practice Address - Country:US
Practice Address - Phone:817-300-1471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8745207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK8745OtherSTATE LICENSE