Basic Information
| Provider Information | |||||||||
| NPI: | 1043267818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UWAIFO | ||||||||
| FirstName: | GABRIEL | ||||||||
| MiddleName: | IKPONMOSA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 JEFFERSON HWY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701212429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2750 GAUSE BLVD E | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704614149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856393777 | ||||||||
| FaxNumber: | 9856613555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 03/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 19937 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | MD.203716 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 106178 | 05 | AL | MEDICAID | 05538368 | 05 | MS | MEDICAID | 1393959 | 05 | LA | MEDICAID | 58884349 | 05 | VA | MEDICAID | 034604200 | 05 | DC | MEDICAID | 106178 | 05 | MS | MEDICAID | 401048500 | 05 | MD | MEDICAID |