Provider Demographics
NPI:1790869279
Name:OBUKOFE, CHRISTIE E (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:E
Last Name:OBUKOFE
Suffix:
Gender:F
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 9789
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77213-0789
Mailing Address - Country:US
Mailing Address - Phone:713-450-3538
Mailing Address - Fax:713-450-0859
Practice Address - Street 1:12871 EAST FREEWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015
Practice Address - Country:US
Practice Address - Phone:713-450-3538
Practice Address - Fax:713-450-0859
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3566207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131824802Medicaid
F52932Medicare UPIN
TX131824802Medicaid