Noble U. Ezukanma, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

K8745 Issued in TX

Practice address

8401 Jacksboro Hwy
Suite 218
Lakeside, TX 76135-4351

Phone

(817) 338-0400

Fax

(817) 338-0401

NPI assigned

Jan 24, 2006

Last updated

Jul 23, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alpha Pulmonary Critical Care Consultants, PLLC

  • Pulmonary Disease Physician
  • Burleson, TX
  • NPI 1295975316
  NPD (past)
• Alpha Pulmonary Critical Care Consultants, PLLC

  • Pulmonary Disease Physician
  • Fort Worth, TX
  • NPI 1609042449
  NPD (past)
• Texas Health Care, P.L.L.C.

  • Family Medicine Physician
  • Fort Worth, TX
  • NPI 1821026352

  Internal Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343001600000",
    "number": "1295705291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 S ADAMS ST",
            "address_2": "SUITE 218",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042147",
            "telephone_number": "817-338-0400",
            "fax_number": "817-338-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 JACKSBORO HWY",
            "address_2": "SUITE 218",
            "city": "LAKESIDE",
            "state": "TX",
            "postal_code": "761354351",
            "telephone_number": "817-338-0400",
            "fax_number": "817-338-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZUKANMA",
        "first_name": "NOBLE",
        "middle_name": "U.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2012-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "K8745",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "TX",
            "license": "K8745",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "TX",
            "license": "K8745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariella E Clark, LCSW
• Kathi Edmonson
• Kimberli Paige Edmonson, SLP-ASSISTANT
• Mainstream Habilitation Services of Texas, Inc.
• Chase C McKinney, LPC
• Pathfinder Counseling and Consulting
• Sage Substance Abuse Guidance and Education
• Kelle Creecy White, LCSW-S

• Pulmonary Disease Physician in Lakeside, TX
• Providers in Lakeside, TX by specialty
• Pulmonary Disease Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.