Provider Demographics
NPI:1467494708
Name:EKANEM, FELIX
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:
Last Name:EKANEM
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:PO BOX 9879
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-2879
Mailing Address - Country:US
Mailing Address - Phone:903-594-2497
Mailing Address - Fax:903-509-0493
Practice Address - Street 1:712 N WOOD ST
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-1751
Practice Address - Country:US
Practice Address - Phone:903-841-7100
Practice Address - Fax:903-841-7219
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3171207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107276108Medicaid
TX107276108Medicaid
TXF84482Medicare UPIN