Healthcare Provider Details

I. General information

NPI: 1083054571
Provider Name (Legal Business Name): CHRISTOPHER UGOCHUKWU UGORJI REX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 10/18/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E MAIN ST STE A
PAYSON AZ
85541-5646
US

IV. Provider business mailing address

127 E MAIN ST STE A
PAYSON AZ
85541-5646
US

V. Phone/Fax

Practice location:
  • Phone: 928-951-0395
  • Fax: 928-494-9319
Mailing address:
  • Phone: 928-951-0395
  • Fax: 928-494-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number56105
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA148673
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number56105
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA148673
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT204558
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: