1972558146 NPI number — DR. EZE DAVID UCHE MD

Table of content: DR. EZE DAVID UCHE MD (NPI 1972558146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972558146 NPI number — DR. EZE DAVID UCHE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UCHE
Provider First Name:
EZE
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARDIOLOGY
Provider Other First Name:
CITRUS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972558146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 W HIGHLAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INVERNESS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34452-4716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-726-8353
Provider Business Mailing Address Fax Number:
352-341-6885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E DIXIE AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34748-7699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-315-0627
Provider Business Practice Location Address Fax Number:
352-315-1012
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME73420 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 252133400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: K0208 . This is a "GRP" identifier . This identifiers is of the category "OTHER".




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