Provider Demographics
NPI:1275738874
Name:AZUBUIKE, EBERE I (MD)
Entity Type:Individual
Prefix:DR
First Name:EBERE
Middle Name:I
Last Name:AZUBUIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WYNNEWOOD VILLAGE
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224
Mailing Address - Country:US
Mailing Address - Phone:214-942-2377
Mailing Address - Fax:214-942-2977
Practice Address - Street 1:501 WYNNEWOOD VILLAGE
Practice Address - Street 2:SUITE 102A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1838
Practice Address - Country:US
Practice Address - Phone:214-942-2377
Practice Address - Fax:214-942-2977
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9136OtherLICENCE