Provider Demographics
NPI:1790701415
Name:OGBONNA, FRANCIS C
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:C
Last Name:OGBONNA
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 1:332 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2977
Mailing Address - Country:US
Mailing Address - Phone:972-322-0048
Mailing Address - Fax:972-298-2909
Practice Address - Street 1:332 BEECHWOOD LN
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2977
Practice Address - Country:US
Practice Address - Phone:972-322-0048
Practice Address - Fax:972-298-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR28642335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179608801Medicaid
TX459896Medicare PIN