Provider Demographics
NPI:1558927962
Name:NWAIGWE, IJEOMA (DO)
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:NWAIGWE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11937 US HWY 271
Mailing Address - Street 2:ATTN: KATE WELLS
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708
Mailing Address - Country:US
Mailing Address - Phone:903-877-7000
Mailing Address - Fax:
Practice Address - Street 1:12421 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6508
Practice Address - Country:US
Practice Address - Phone:407-859-5656
Practice Address - Fax:407-859-2124
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10068780390200000X
FLOS18985208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine