Provider Demographics
NPI:1821000225
Name:UKPONMWAN, UYIGUE EGBE (MD)
Entity Type:Individual
Prefix:
First Name:UYIGUE
Middle Name:EGBE
Last Name:UKPONMWAN
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 1:6200 W PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8185
Mailing Address - Country:US
Mailing Address - Phone:972-981-3225
Mailing Address - Fax:972-981-3967
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8185
Practice Address - Country:US
Practice Address - Phone:972-981-3225
Practice Address - Fax:972-981-3967
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA630031H207Q00000X
TXR0149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4314981OtherMEDICARE PTAN
KY7100151960Medicaid
OH3119039Medicaid