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Individual

GLORY OKUGO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
18780 INTERSTATE 20, CANTON, TX 75103-3593
(903) 567-7748
Mailing address
1131 MEADOW CREEK DR., 258, IRVING, TX 75038

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
288233
NY
207P00000X
Emergency Medicine Physician
Primary
S9197
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1M0904
MEDICARE
TX
Enumeration date
04/04/2014
Last updated
03/18/2021
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