Provider Demographics
NPI:1194990424
Name:DIM, UZODINMA RAPHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:UZODINMA
Middle Name:RAPHAEL
Last Name:DIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2200 GEORGE DIETER DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3915
Mailing Address - Country:US
Mailing Address - Phone:915-248-2434
Mailing Address - Fax:
Practice Address - Street 1:2200 GEORGE DIETER DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3915
Practice Address - Country:US
Practice Address - Phone:915-248-2434
Practice Address - Fax:915-248-2443
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230246207RC0000X, 207RC0001X, 207RI0011X
TXP0720207RC0000X, 207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286895201Medicaid
TXTXB141183Medicare UPIN