Provider Demographics
NPI:1104011444
Name:UKAEGBU, CHIBUZO ONYEZE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CHIBUZO
Middle Name:ONYEZE
Last Name:UKAEGBU
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13969
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-3969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:575-652-3213
Practice Address - Street 1:3885 FOOTHILLS RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4672
Practice Address - Country:US
Practice Address - Phone:575-556-9837
Practice Address - Fax:575-652-3213
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD 2008-0255207Q00000X
NMMD2008-0255207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM50538756Medicaid
NM50538756Medicaid