Basic Information
| Provider Information | |||||||||
| NPI: | 1467494708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EKANEM | ||||||||
| FirstName: | FELIX | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9879 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757112879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035942497 | ||||||||
| FaxNumber: | 9035090493 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 N WOOD ST | ||||||||
| Address2: | |||||||||
| City: | GILMER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756441751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038417100 | ||||||||
| FaxNumber: | 9038417219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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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 | 207P00000X | K3171 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 107276108 | 05 | TX | MEDICAID |