Provider Demographics
NPI:1417157397
Name:AKOMA, UGOCHUKWU E (MD)
Entity Type:Individual
Prefix:DR
First Name:UGOCHUKWU
Middle Name:E
Last Name:AKOMA
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 1:161 TAI GIGAO RD
Mailing Address - Street 2:
Mailing Address - City:AGANA HEIGHTS
Mailing Address - State:GU
Mailing Address - Zip Code:96910-6122
Mailing Address - Country:US
Mailing Address - Phone:671-777-2874
Mailing Address - Fax:
Practice Address - Street 1:633 GOV CARLOS G CAMACHO RD STE 103
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3143
Practice Address - Country:US
Practice Address - Phone:671-588-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40961207Q00000X
GUM-2055207Q00000X
TXPROVISIONAL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440163201OtherARKANSAS MEDICAID TEMP RX