MEDICARE: DR. EZINNE CHARITY NWUDE 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	E-8288	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710273891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EZINNE CHARITY NWUDE M.D.

Provider Business Mailing Address
First Line	:	100 E CHURCH ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4602
Country	:	US
Telephone Number	:	870-862-2331
Fax Number	:	870-862-2322

Provider Business Practice Location Address
First Line	:	100 E CHURCH ST
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4602
Country	:	US
Telephone Number	:	870-862-2331
Fax Number	:

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	05/03/2024

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