Provider Demographics
NPI:1851470298
Name:OKAFOR, CECILIA NNENNA (DO)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:NNENNA
Last Name:OKAFOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:204 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2803
Mailing Address - Country:US
Mailing Address - Phone:214-398-0398
Mailing Address - Fax:214-398-7200
Practice Address - Street 1:1143 S BUCKNER BLVD
Practice Address - Street 2:STE 144
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4304
Practice Address - Country:US
Practice Address - Phone:214-398-0398
Practice Address - Fax:214-398-7200
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146609602OtherTHSTEP
H0000006HPOtherBLUE CROSS BLUE SHIELD
TX146609601Medicaid
TX752949110OtherTAX ID
TX2706801OtherAETNA
TX752949110OtherTAX ID
TX146609602OtherTHSTEP