Basic Information
| Provider Information | |||||||||
| NPI: | 1417477613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKAFOR | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | IKENNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12317 ABBEY GDN | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782492791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126595086 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11212 STATE HIGHWAY 151 | ||||||||
| Address2: | SUITE 105-MEDICAL PLAZA II | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103091405 | ||||||||
| FaxNumber: | 2104775224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA11284 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.