Provider Demographics
NPI:1144501875
Name:MGBOKWERE, CHIOMA J (MD)
Entity type:Individual
Prefix:
First Name:CHIOMA
Middle Name:J
Last Name:MGBOKWERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 EASTLAKE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7297
Mailing Address - Country:US
Mailing Address - Phone:915-577-1134
Mailing Address - Fax:915-577-1136
Practice Address - Street 1:13800 EASTLAKE DR
Practice Address - Street 2:SUITE400
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7297
Practice Address - Country:US
Practice Address - Phone:915-577-1134
Practice Address - Fax:915-577-1136
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0856207P00000X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX299693603Medicaid
TXP01279531OtherMEDICARE RAILROAD
TX313532YKN5Medicare PIN