Provider Demographics
NPI:1992760821
Name:IZUEGBUNAM, GODWIN C (MD)
Entity type:Individual
Prefix:
First Name:GODWIN
Middle Name:C
Last Name:IZUEGBUNAM
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 1:44047 N 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-6100
Mailing Address - Country:US
Mailing Address - Phone:602-595-2986
Mailing Address - Fax:602-595-3041
Practice Address - Street 1:8910 N 43RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5340
Practice Address - Country:US
Practice Address - Phone:602-595-2986
Practice Address - Fax:602-595-3041
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31461207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ793837Medicaid
CAP00160135OtherRAILROAD MEDICARE
NV100504308Medicaid
AZAZ0758850OtherBCBS OF AZ
CAXPY201416OtherMEDI CAL
NV100504308Medicaid