Provider Demographics
NPI:1235517087
Name:OGBONNA, IFEOMA TAMARA (MD)
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:TAMARA
Last Name:OGBONNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SIMS DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-7711
Mailing Address - Country:US
Mailing Address - Phone:469-777-0778
Mailing Address - Fax:615-327-6783
Practice Address - Street 1:402 W WHEATLAND RD STE 140
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4628
Practice Address - Country:US
Practice Address - Phone:972-503-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN568862083X0100X
TXS03472083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine