MEDICARE: CHARLES C. UGOKWE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	13814R	LA
2	2084N0400X	Neurology Physician	13814R	LA

General Provider Information

NPI Number	:	1144210717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES C. UGOKWE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 12911
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71315-2911
Country	:	US
Telephone Number	:	318-473-0773
Fax Number	:	318-473-0836

Provider Business Practice Location Address
First Line	:	2223 WORLEY DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3631
Country	:	US
Telephone Number	:	318-473-0773
Fax Number	:	318-473-0836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	09/05/2017

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