Provider Demographics
NPI:1396232039
Name:IFEOMA EGBUONU, MD, PLLC
Entity Type:Organization
Organization Name:IFEOMA EGBUONU, MD, PLLC
Other - Org Name:DIABETES AND ENDOCRINOLOGY SPECIALISTS OF EL PASO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:ANTHONIA
Authorized Official - Last Name:EGBUONU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-525-7576
Mailing Address - Street 1:4849 N MESA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5919
Mailing Address - Country:US
Mailing Address - Phone:915-351-6600
Mailing Address - Fax:915-351-6601
Practice Address - Street 1:2270 JOE BATTLE BLVD STE O
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938
Practice Address - Country:US
Practice Address - Phone:915-856-7000
Practice Address - Fax:915-275-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty