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NPI Code Detail

MEDICARE: UWAYEMWEN OGBONMWONKPA AIDEYAN MD

MEDICARE: UWAYEMWEN OGBONMWONKPA AIDEYAN MD
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
12085P0229XPediatric Radiology PhysicianME69757FL
22085R0202XDiagnostic Radiology PhysicianME69757FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300132744OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
228338OTHERFLAVMED
328338OTHERFLBLUE CROSS BLUE SHIELD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295738425
Entity Type Code : Individual
Provider Name (Legal Business Name) : UWAYEMWEN OGBONMWONKPA AIDEYAN MD
Provider Business Mailing Address
First Line : PO BOX 5270
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32247-5720
Country : US
Telephone Number : 904-288-5650
Fax Number : 407-650-7578
Provider Business Practice Location Address
First Line : 807 CHILDREN'S WAY
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8426
Country : US
Telephone Number : 904-390-3600
Fax Number : 904-390-3592
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 03/07/2023

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