Healthcare Provider Details

I. General information

NPI: 1104011444
Provider Name (Legal Business Name): CHIBUZO ONYEZE UKAEGBU MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 FOOTHILLS RD SUITE B
LAS CRUCES NM
88011-4672
US

IV. Provider business mailing address

PO BOX 13969
LAS CRUCES NM
88013-3969
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9837
  • Fax: 575-652-3213
Mailing address:
  • Phone:
  • Fax: 575-652-3213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 2008-0255
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD2008-0255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: