Provider Demographics
NPI:1265465629
Name:EZE, BRIGHT OKECHUKWU (MA)
Entity Type:Individual
Prefix:MR
First Name:BRIGHT
Middle Name:OKECHUKWU
Last Name:EZE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W SARAGOSA ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5644
Mailing Address - Country:US
Mailing Address - Phone:480-726-1797
Mailing Address - Fax:480-726-7898
Practice Address - Street 1:1510 W SARAGOSA ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5644
Practice Address - Country:US
Practice Address - Phone:480-726-1797
Practice Address - Fax:480-726-7898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-5673171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ098970OtherAHCCCS