Healthcare Provider Details

I. General information

NPI: 1720336159
Provider Name (Legal Business Name): DR. KELECHI OGBUJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 06/21/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 HARRISON AVE
PANAMA CITY FL
32405-4542
US

IV. Provider business mailing address

1940 HARRISON AVE
PANAMA CITY FL
32405-4542
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0017
  • Fax: 850-532-6454
Mailing address:
  • Phone: 850-763-0017
  • Fax: 850-532-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number281896
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME133739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: