Provider Demographics
NPI:1518027481
Name:UGHWANOGHO, EJOVI (MD)
Entity Type:Individual
Prefix:
First Name:EJOVI
Middle Name:
Last Name:UGHWANOGHO
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 1:3815 E BELL RD STE 2700
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2155
Mailing Address - Country:US
Mailing Address - Phone:602-714-6970
Mailing Address - Fax:602-714-5176
Practice Address - Street 1:13760 N 93RD AVE STE 203
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4200
Practice Address - Country:US
Practice Address - Phone:602-714-6970
Practice Address - Fax:602-714-5176
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46957207XS0117X, 208600000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ46957OtherARIZONA MEDICAL LICENSE
AZ757351Medicaid
AZ46957OtherARIZONA MEDICAL LICENSE