Provider Demographics
NPI:1295738425
Name:AIDEYAN, UWAYEMWEN OGBONMWONKPA (MD)
Entity type:Individual
Prefix:
First Name:UWAYEMWEN
Middle Name:OGBONMWONKPA
Last Name:AIDEYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:UWA
Other - Middle Name:
Other - Last Name:AIDEYAN-ALEXIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5270
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-5720
Mailing Address - Country:US
Mailing Address - Phone:904-288-5650
Mailing Address - Fax:407-650-7578
Practice Address - Street 1:807 CHILDREN'S WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:904-390-3600
Practice Address - Fax:904-390-3592
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME697572085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300132744OtherRAILROAD MEDICARE
FL28338OtherAVMED
FL28338OtherBLUE CROSS BLUE SHIELD
FL379203000Medicaid
FL379203000Medicaid
FL28338OtherAVMED
FLF81729Medicare UPIN