Provider Demographics
NPI:1689054223
Name:UGWU, JESSICA EZINNE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:EZINNE
Last Name:UGWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:EZINNE
Other - Last Name:OSIZUGBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 E APPLE ST.
Mailing Address - Street 2:SUITE NW 3300
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:937-208-8394
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:30 E APPLE ST.
Practice Address - Street 2:SUITE NW 3300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-8394
Practice Address - Fax:937-440-4470
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.133039207Q00000X
TXBP10053885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine