Provider Demographics
NPI:1912045030
Name:CHRISTIE E. OBUKOFE M.D. PA
Entity Type:Organization
Organization Name:CHRISTIE E. OBUKOFE M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OBUKOFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-450-3538
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3566207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131824802Medicaid
TX0011BVMedicare ID - Type Unspecified
TX131824802Medicaid