Provider Demographics
NPI:1750324026
Name:IREH, UGO ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:UGO
Middle Name:ALEXIS
Last Name:IREH
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 1:209 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3518
Mailing Address - Country:US
Mailing Address - Phone:229-758-3385
Mailing Address - Fax:229-758-5198
Practice Address - Street 1:209 N CUTHBERT ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3518
Practice Address - Country:US
Practice Address - Phone:229-758-3385
Practice Address - Fax:229-758-5198
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55851208600000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003228061BMedicaid