Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 25MD00296800 | NJ |
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00296800 | NJ |
NPI | 1386805919 |
---|---|
Provider Name | Dr. Ndidi Ufondu |
First Address | Bedford, TX 76095-7773 |
Second Address | Bedford, TX 76021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 25/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023310117 | NPI GROUP (01) | NJ |
134913 | MEDICARE (01) | NJ |
134914 | MEDICARE (01) | NJ |
191239 | MEDICARE PTAN (01) | NJ |