Provider Demographics
NPI:1497830798
Name:OKOJIE, GODWIN E (PA)
Entity Type:Individual
Prefix:
First Name:GODWIN
Middle Name:E
Last Name:OKOJIE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 ROSS AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5138
Mailing Address - Country:US
Mailing Address - Phone:214-515-9646
Mailing Address - Fax:
Practice Address - Street 1:4801 BRYAN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8300
Practice Address - Country:US
Practice Address - Phone:214-515-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011499363A00000X
CAPA 18648363A00000X
TXPA05751363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02821332Medicaid