Individual
DESMOND OKEY IKONDU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2502 W TRENTON RD, EDINBURG, TX 78539-8070
(956) 630-2119
(956) 682-6115
Mailing address
2502 W TRENTON RD, EDINBURG, TX 78539-8070
(956) 630-2119
(956) 682-6115
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
L1348
TX
207Q00000X
Family Medicine Physician
Primary
L1348
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0075GC
BCBS
TX
01
—
00Z798
MEDICARE PTAN -5/1/08
TX
01
—
113464
SUPERIOR HEALTH CARE
TX
05
—
141060401
—
TX
01
—
141660401
INDIV TPI MEDICIAID
TX
05
—
141660402
—
TX
05
—
141660405
—
TX
05
—
141660407
—
TX
01
—
201528101
GROUP TPI MEDICIAID
TX
Enumeration date
11/16/2005
Last updated
10/10/2013
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