Provider Demographics
NPI:1912521253
Name:UDEH, HILLARY OSITA (MD)
Entity type:Individual
Prefix:MR
First Name:HILLARY
Middle Name:OSITA
Last Name:UDEH
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 1:207 W GARLAND APT 5
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-2498
Mailing Address - Country:US
Mailing Address - Phone:704-769-9503
Mailing Address - Fax:
Practice Address - Street 1:638 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701
Practice Address - Country:US
Practice Address - Phone:870-836-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE14751207Q00000X
ARE-14751207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine