Basic Information
| Provider Information | |||||||||
| NPI: | 1588957005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EGUDU | ||||||||
| FirstName: | DORITA | ||||||||
| MiddleName: | CHINENYE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 HODGES DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504315741 | ||||||||
| FaxNumber: | 8504316403 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 HODGES DR | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504315741 | ||||||||
| FaxNumber: | 8504316403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2011 | ||||||||
| LastUpdateDate: | 04/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME117588 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.