Provider Demographics
NPI:1316112105
Name:UDEOZO, CHIDEBE (MD)
Entity type:Individual
Prefix:
First Name:CHIDEBE
Middle Name:
Last Name:UDEOZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 RAMSEY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4952
Mailing Address - Country:US
Mailing Address - Phone:910-723-7959
Mailing Address - Fax:910-323-1282
Practice Address - Street 1:300 E MCKAY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9037
Practice Address - Country:US
Practice Address - Phone:910-862-5500
Practice Address - Fax:910-862-5501
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2011-01366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC386175Medicaid
NC5918919Medicaid