Provider Demographics
NPI:1952300444
Name:OBIALO, EBELE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:EBELE
Middle Name:ELIZABETH
Last Name:OBIALO
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 378
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-0378
Mailing Address - Country:US
Mailing Address - Phone:972-492-9901
Mailing Address - Fax:972-492-9902
Practice Address - Street 1:4100 FAIRWAY DR STE 620
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6539
Practice Address - Country:US
Practice Address - Phone:972-492-9901
Practice Address - Fax:972-492-9902
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8392207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M7340OtherBCBS
TX144194123Medicaid
TX8C1252Medicare PIN
TX144194123Medicaid