Provider Demographics
NPI:1760596563
Name:NWORA, JOHN OKECHUKWU (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:OKECHUKWU
Last Name:NWORA
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:PO BOX 200
Mailing Address - Street 2:1117 WARD AVE
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-0200
Mailing Address - Country:US
Mailing Address - Phone:573-333-4441
Mailing Address - Fax:573-333-5142
Practice Address - Street 1:1117 WARD AVE
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-2622
Practice Address - Country:US
Practice Address - Phone:573-333-4441
Practice Address - Fax:573-333-5142
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207679200Medicaid
000014513Medicare ID - Type Unspecified
MO207679200Medicaid