Provider Demographics
NPI:1073286142
Name:OFFIONG, EDIDIONG (MD)
Entity type:Individual
Prefix:DR
First Name:EDIDIONG
Middle Name:
Last Name:OFFIONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 E CHESTNUT EXPY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2698
Mailing Address - Country:US
Mailing Address - Phone:417-885-2200
Mailing Address - Fax:
Practice Address - Street 1:3253 E CHESTNUT EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2698
Practice Address - Country:US
Practice Address - Phone:417-885-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024026006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine