Provider Demographics
NPI:1629237359
Name:ANYAUGO, UGONNA UZOCHUKWU (DPM)
Entity Type:Individual
Prefix:
First Name:UGONNA
Middle Name:UZOCHUKWU
Last Name:ANYAUGO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 COUNTRYSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1605
Mailing Address - Country:US
Mailing Address - Phone:727-797-5008
Mailing Address - Fax:727-791-8517
Practice Address - Street 1:2521 COUNTRYSIDE BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1605
Practice Address - Country:US
Practice Address - Phone:727-797-5008
Practice Address - Fax:727-791-8517
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3483213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEY899ZMedicare UPIN