Provider Demographics
NPI:1396009668
Name:EZIRIM, NKECHI (MD)
Entity type:Individual
Prefix:
First Name:NKECHI
Middle Name:
Last Name:EZIRIM
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 1:420 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4517
Mailing Address - Country:US
Mailing Address - Phone:432-582-8757
Mailing Address - Fax:432-582-8757
Practice Address - Street 1:420 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4517
Practice Address - Country:US
Practice Address - Phone:432-582-8757
Practice Address - Fax:432-582-8757
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058651207V00000X
VA0101255661207V00000X
TXQ9345207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380846102Medicaid
TX380846101Medicaid
NM73888770Medicaid
OK200752300AMedicaid