Provider Demographics
NPI:1477972172
Name:ONYEGBULE, BARTH
Entity Type:Individual
Prefix:MR
First Name:BARTH
Middle Name:
Last Name:ONYEGBULE
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 1:737 OKIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-3307
Mailing Address - Country:US
Mailing Address - Phone:405-889-6268
Mailing Address - Fax:
Practice Address - Street 1:3601 N CLASSEN BLVD
Practice Address - Street 2:107
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-3231
Practice Address - Country:US
Practice Address - Phone:405-601-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator