Individual
DR. NOBLE U. EZUKANMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8401 JACKSBORO HWY, SUITE 218, LAKESIDE, TX 76135-4351
(817) 338-0400
(817) 338-0401
Mailing address
508 S ADAMS ST, SUITE 218, FORT WORTH, TX 76104-2147
(817) 338-0400
(817) 338-0401
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
K8745
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
K8745
TX
207RP1001X
Pulmonary Disease Physician
Primary
K8745
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044684101
—
TX
Enumeration date
01/24/2006
Last updated
07/23/2012
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