Provider Demographics
NPI:1427411073
Name:EZIGBO, PATCHELY
Entity Type:Individual
Prefix:MR
First Name:PATCHELY
Middle Name:
Last Name:EZIGBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 S FORUM DR APT 2203
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7028
Mailing Address - Country:US
Mailing Address - Phone:903-917-3901
Mailing Address - Fax:
Practice Address - Street 1:2650 S FORUM DR
Practice Address - Street 2:SUIT 2203
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7025
Practice Address - Country:US
Practice Address - Phone:903-917-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health