Provider Demographics
NPI:1629076419
Name:NWAKOBY, IZU E (MD)
Entity Type:Individual
Prefix:
First Name:IZU
Middle Name:E
Last Name:NWAKOBY
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 1:2980 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0421
Mailing Address - Country:US
Mailing Address - Phone:352-622-4231
Mailing Address - Fax:352-622-0513
Practice Address - Street 1:2980 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0421
Practice Address - Country:US
Practice Address - Phone:352-622-4231
Practice Address - Fax:352-622-0513
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2008-09-25
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
FLME85083207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265030400Medicaid
FL110237945OtherRRMC (IND)
FLCD4677OtherRRMC (GRP)
FLH63544Medicare UPIN
FL265030400Medicaid