Provider Demographics
NPI:1629111018
Name:OKPARA, DOUGLAS EGEONU (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EGEONU
Last Name:OKPARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19301 S SANTA FE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-5920
Mailing Address - Country:US
Mailing Address - Phone:310-631-5655
Mailing Address - Fax:310-631-3625
Practice Address - Street 1:19301 S SANTA FE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-5920
Practice Address - Country:US
Practice Address - Phone:310-631-5655
Practice Address - Fax:310-631-3625
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G534440Medicaid
CAG53444AMedicare ID - Type UnspecifiedPROVIDER NUMBER
CAA93226Medicare UPIN