Healthcare Provider Details

I. General information

NPI: 1841274446
Provider Name (Legal Business Name): JOVITA UN ORUWARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOVITA U NKWODIMMAH

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 DE PAUL LN STE 104
BRIDGETON MO
63044-3546
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 314-209-5225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2001016937
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2001016937
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: