Provider Demographics
NPI:1639154248
Name:IBEGBU, IKECHUKWU ERIC (MD)
Entity Type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:ERIC
Last Name:IBEGBU
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 1:4 JOSH CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-0052
Mailing Address - Country:US
Mailing Address - Phone:910-577-3636
Mailing Address - Fax:
Practice Address - Street 1:4 JOSH COURT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5253
Practice Address - Country:US
Practice Address - Phone:910-577-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401229207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900314Medicaid
P00310404OtherRAILROAD MEDICARE
NC5900314Medicaid
2039869CMedicare PIN