Provider Demographics
NPI:1447575931
Name:ILUBA, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ILUBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:UNAEZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2505 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4464
Mailing Address - Country:US
Mailing Address - Phone:772-313-3768
Mailing Address - Fax:850-522-5384
Practice Address - Street 1:658 N CHASE ST # 102
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1960
Practice Address - Country:US
Practice Address - Phone:772-313-3768
Practice Address - Fax:850-522-8354
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33945207ND0101X
IN01073699A207ND0101X
GA93791207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA93791OtherGA MEDICAL LICENSE