Provider Demographics
NPI:1518931690
Name:NWAFOR, TOCHUKWU SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TOCHUKWU
Middle Name:SAMUEL
Last Name:NWAFOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S LINDSAY RD
Mailing Address - Street 2:STE 123
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-2100
Mailing Address - Country:US
Mailing Address - Phone:602-244-2700
Mailing Address - Fax:602-629-1024
Practice Address - Street 1:3303 S LINDSAY RD STE 123
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-821-9339
Practice Address - Fax:480-821-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ29620OtherMEDICAL LICENSE
AZ635617Medicaid
AZ100722Medicare ID - Type Unspecified
AZ635617Medicaid