Provider Demographics
NPI:1780749200
Name:UKOH, GODFREY O
Entity type:Individual
Prefix:
First Name:GODFREY
Middle Name:O
Last Name:UKOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14601 BELLAIRE BLVD STE 145
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2540
Mailing Address - Country:US
Mailing Address - Phone:281-933-8700
Mailing Address - Fax:281-933-4992
Practice Address - Street 1:14601 BELLAIRE BLVD STE 145
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-2540
Practice Address - Country:US
Practice Address - Phone:281-933-8700
Practice Address - Fax:281-933-4992
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0064410171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4620700001Medicare ID - Type UnspecifiedPROVIDER INUMBER