Individual
DR. IKENNA I EGBUNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3270 JOE BATTLE BLVD, 245, EL PASO, TX 79938-2639
(915) 702-0165
(915) 702-0167
Mailing address
3270 JOE BATTLE BLVD, 245, EL PASO, TX 79938-2639
(915) 702-0165
(915) 702-0167
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
01070397A
IN
207RG0100X
Gastroenterology Physician
Primary
P1638
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000750628
ANTHEM PROVIDER NUMBER
IN
05
—
201049570
—
IN
01
—
241127
LICENSE
NY
Enumeration date
02/07/2007
Last updated
03/07/2023
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