Provider Demographics
NPI:1861547077
Name:OCHULO, BOB NNANYEREUGO (MT)
Entity type:Individual
Prefix:MR
First Name:BOB
Middle Name:NNANYEREUGO
Last Name:OCHULO
Suffix:
Gender:M
Credentials:MT
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Mailing Address - Street 1:1908 TENNYSON DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3744
Mailing Address - Country:US
Mailing Address - Phone:214-244-3852
Mailing Address - Fax:972-691-8017
Practice Address - Street 1:1908 TENNYSON DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3744
Practice Address - Country:US
Practice Address - Phone:214-244-3852
Practice Address - Fax:972-691-8017
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL8262Medicare ID - Type UnspecifiedPROVIDER NUMBER