Provider Demographics
NPI:1902901531
Name:NDEKWE, HENRY-NORBERT O (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY-NORBERT
Middle Name:O
Last Name:NDEKWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6334
Mailing Address - Country:US
Mailing Address - Phone:580-581-1994
Mailing Address - Fax:580-581-1285
Practice Address - Street 1:3805 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6334
Practice Address - Country:US
Practice Address - Phone:580-581-1994
Practice Address - Fax:580-581-1285
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21147 OK174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100046890AMedicaid
OK100046890AMedicaid
OKG99918Medicare UPIN