Provider Demographics
NPI:1477815496
Name:UDOFIA, ANIEBIET-ABASI UKO BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIEBIET-ABASI
Middle Name:UKO BENJAMIN
Last Name:UDOFIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 MEDICAL PARK LN STE D
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4957
Mailing Address - Country:US
Mailing Address - Phone:936-755-4690
Mailing Address - Fax:936-755-4706
Practice Address - Street 1:125 MEDICAL PARK LN STE D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4957
Practice Address - Country:US
Practice Address - Phone:936-755-4690
Practice Address - Fax:936-755-4706
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8501207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine