Provider Demographics
NPI:1316993918
Name:OGBUCHI, SAMPSON (MD)
Entity type:Individual
Prefix:
First Name:SAMPSON
Middle Name:
Last Name:OGBUCHI
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:PO BOX 11047
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-1047
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:600 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5304
Practice Address - Country:US
Practice Address - Phone:386-274-7800
Practice Address - Fax:386-274-7800
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD20946207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051543167OtherBCBS
AL51090042OtherBCBS
LAP01061967OtherRRMCARE THRU GPN MANY
AL009911672Medicaid
AL009930700Medicaid
LA2147501Medicaid
LA4Q121DT25Medicare PIN
LAP01061967OtherRRMCARE THRU GPN MANY
AL051543167OtherBCBS
AL009930700Medicaid