Provider Demographics
NPI:1881848505
Name:EKWENUGO, GOZIE AGHAEGBUNAM (RT)
Entity Type:Individual
Prefix:MR
First Name:GOZIE
Middle Name:AGHAEGBUNAM
Last Name:EKWENUGO
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 170566
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-0566
Mailing Address - Country:US
Mailing Address - Phone:214-869-1133
Mailing Address - Fax:972-602-0157
Practice Address - Street 1:3525 CANYON RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7852
Practice Address - Country:US
Practice Address - Phone:214-869-1133
Practice Address - Fax:972-602-0157
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX11144247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist