Provider Demographics
NPI:1164622908
Name:WOGU, ELIJAH UZOMA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:UZOMA
Last Name:WOGU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1655 DALIDIO DR UNIT 4156
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-7036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 CALIFORNIA BLVD
Practice Address - Street 2:J
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2541
Practice Address - Country:US
Practice Address - Phone:805-543-4319
Practice Address - Fax:805-543-0446
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD8239207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery