Provider Demographics
NPI:1407086333
Name:EKPENYONG, UDEME (MD)
Entity Type:Individual
Prefix:DR
First Name:UDEME
Middle Name:
Last Name:EKPENYONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N. 4TH ST.
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-236-8600
Mailing Address - Fax:903-236-8605
Practice Address - Street 1:818 N. 4TH ST.
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-236-8600
Practice Address - Fax:903-236-8605
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2982208000000X, 2080A0000X, 2080A0000X
AL296622080I0007X, 2080N0001X, 2080P0202X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080I0007XAllopathic & Osteopathic PhysiciansPediatricsClinical & Laboratory Immunology
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine