Provider Demographics
NPI:1154161057
Name:MGBUDOMOBI, UGOCHUKWU SUCCESS (MD)
Entity type:Individual
Prefix:MR
First Name:UGOCHUKWU
Middle Name:SUCCESS
Last Name:MGBUDOMOBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 EAST A STREET
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601
Mailing Address - Country:US
Mailing Address - Phone:307-234-6161
Mailing Address - Fax:307-234-7033
Practice Address - Street 1:1522 EAST A STREET
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-234-6161
Practice Address - Fax:307-234-7033
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program