Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | ME76735 | FL |
Y | 2081P2900X | Pain Medicine | ME76735 | FL |
N | 2081S0010X | Sports Medicine | ME76735 | FL |
N | 213ES0000X | Sports Medicine | ME76735 | FL |
NPI | 1962489864 |
---|---|
Provider Name | Dr. Nnamdi C. Nwaogwugwu |
First Address | Orlando, FL 32811-2617 |
Second Address | Orlando, FL 32811-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 15/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G82886 | (02) | FL |