Provider Demographics
NPI:1659690642
Name:IBE, WILLIAM OKECHUKU
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:OKECHUKU
Last Name:IBE
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 1:3002 CREEK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2890
Mailing Address - Country:US
Mailing Address - Phone:972-675-5421
Mailing Address - Fax:972-675-5421
Practice Address - Street 1:3002 CREEK VALLEY DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2890
Practice Address - Country:US
Practice Address - Phone:972-675-5421
Practice Address - Fax:972-675-5421
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608952279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13-4259203OtherEIN