Provider Demographics
NPI:1376708222
Name:OBI, CHIZOBA C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIZOBA
Middle Name:C
Last Name:OBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2310 DE LEE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2815
Mailing Address - Country:US
Mailing Address - Phone:979-485-9496
Mailing Address - Fax:979-485-9497
Practice Address - Street 1:2310 DE LEE ST STE 100
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2815
Practice Address - Country:US
Practice Address - Phone:979-485-9496
Practice Address - Fax:979-485-9497
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9423207RN0300X, 207RN0300X
MO2008013207207R00000X
TXP423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1376708222Medicaid
MOP00985983OtherRAILROAD MEDICARE
TX1J4970OtherMEDICARE
MO431560263OtherTRICARE
AR188674001Medicaid
MOP00985983OtherRR MCR
TX339879412Medicaid
TXP02596718OtherRR MEDICARE