Eliora LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ELIORA LLC

Practice address

305 Trail Dust Dr
Southlake, TX 76092-5733

Phone

(817) 807-1714

Fax

(917) 898-1391

NPI assigned

Jan 12, 2024

Organization subpart

No

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

Authorized official

Name

Lauretta U Ogbue, MDNPI 1003807462

Title

Owner

Phone

(817) 807-1714

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lauretta Ufuoma Ogbue, MD

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1003807462
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1881465367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 E SOUTHLAKE BLVD STE 120-342",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 TRAIL DUST DR",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925733",
            "telephone_number": "817-807-1714",
            "fax_number": "917-898-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIORA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "OGBUE",
        "authorized_official_first_name": "LAURETTA",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-807-1714",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.