Provider Demographics
NPI:1245893916
Name:EJIOFOR, EZINWANNEAMAKA MORAYO (MD)
Entity type:Individual
Prefix:DR
First Name:EZINWANNEAMAKA
Middle Name:MORAYO
Last Name:EJIOFOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EZINWANNEAMAKA
Other - Middle Name:MORAYO
Other - Last Name:IGWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:1800 S A W GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7424
Practice Address - Country:US
Practice Address - Phone:512-244-5700
Practice Address - Fax:512-244-5724
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT9904207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine