Provider Demographics
NPI:1912957853
Name:UDEKWU, ANTHONY O (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:O
Last Name:UDEKWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1887 KINGSLEY AVE
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4416
Mailing Address - Country:US
Mailing Address - Phone:904-272-9041
Mailing Address - Fax:904-276-9992
Practice Address - Street 1:1887 KINGSLEY AVE
Practice Address - Street 2:SUITE 1900
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4416
Practice Address - Country:US
Practice Address - Phone:904-272-9041
Practice Address - Fax:904-276-9992
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038648E2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001091690Medicaid
B40669Medicare UPIN