Provider Demographics
NPI:1417198953
Name:ODOCHA, OKAY H (MD)
Entity Type:Individual
Prefix:DR
First Name:OKAY
Middle Name:H
Last Name:ODOCHA
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 1:1302 E 32ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7215
Mailing Address - Country:US
Mailing Address - Phone:575-956-6633
Mailing Address - Fax:575-956-6615
Practice Address - Street 1:1302 E 32ND ST STE A
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7215
Practice Address - Country:US
Practice Address - Phone:575-956-6633
Practice Address - Fax:575-956-6615
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2009-0004208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery