Provider Demographics
NPI:1255527719
Name:EZE D. UCHE, M.D., PA
Entity type:Organization
Organization Name:EZE D. UCHE, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:352-360-0058
Mailing Address - Street 1:4646 VIA DEL MEDICO
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6995
Mailing Address - Country:US
Mailing Address - Phone:352-360-0058
Mailing Address - Fax:352-360-0024
Practice Address - Street 1:4646 VIA DEL MEDICO
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6995
Practice Address - Country:US
Practice Address - Phone:352-360-0058
Practice Address - Fax:352-360-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060048208OtherRAILROAD MEDICARE
FL252133400Medicaid
FL060048208OtherRAILROAD MEDICARE
FLK0208Medicare PIN