Provider Demographics
NPI:1043479462
Name:UKAEGBU, VICTOR (NP-C)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:UKAEGBU
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8307 KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3905
Mailing Address - Country:US
Mailing Address - Phone:713-242-7707
Mailing Address - Fax:713-796-9779
Practice Address - Street 1:C/O GARDEN TERRACE
Practice Address - Street 2:7887 CAMBRIDGE ST
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:832-244-2808
Practice Address - Fax:281-201-4416
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704263363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L2232Medicare PIN