Provider Demographics
NPI:1710964242
Name:AZUOGU, ONYEMEZE (MD)
Entity Type:Individual
Prefix:
First Name:ONYEMEZE
Middle Name:
Last Name:AZUOGU
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:PO BOX 7127
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-7127
Mailing Address - Country:US
Mailing Address - Phone:480-456-9500
Mailing Address - Fax:480-820-7623
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-456-9500
Practice Address - Fax:480-820-7623
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27367208000000X, 2080P0204X
TXP47322080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX582573YKT8OtherMEDICARE
TX8GV655OtherBCBS TX
AZ476722Medicaid
TX582573YKT8OtherMEDICARE
62129Medicare ID - Type Unspecified