Provider Demographics
NPI:1598749301
Name:OKEREKE, PHYLLIS CHIZOMAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:CHIZOMAM
Last Name:OKEREKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-3067
Mailing Address - Country:US
Mailing Address - Phone:956-550-0200
Mailing Address - Fax:956-550-0215
Practice Address - Street 1:110 UPTOWN AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7563
Practice Address - Country:US
Practice Address - Phone:956-550-0200
Practice Address - Fax:956-550-0215
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9375207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1760633326-2000OtherTEXAS DIABETIC COUNSEL
TX0094EQOtherBLUE CROSS BLUE SHEILD
TX0306821-01Medicaid
TXH16207Medicare UPIN
TX00595LMedicare ID - Type Unspecified
TX4090890001Medicare NSC