Individual
DR. THEODORE E OKECHUKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
(601) 984-5939
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5900
(601) 984-5939
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
L0888
TX
207LP3000X
Pediatric Anesthesiology Physician
Primary
20921
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03128719
—
MS
01
—
302I059809
MEDICARE PTAN
MS
Enumeration date
06/13/2006
Last updated
08/29/2013
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