Individual
UWAYEMWEN OGBONMWONKPA AIDEYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
807 CHILDREN'S WAY, JACKSONVILLE, FL 32207-8426
(904) 390-3600
(904) 390-3592
Mailing address
PO BOX 5270, JACKSONVILLE, FL 32247-5720
(904) 288-5650
(407) 650-7578
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
ME69757
FL
2085R0202X
Diagnostic Radiology Physician
ME69757
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28338
AVMED
FL
01
—
300132744
RAILROAD MEDICARE
FL
05
—
379203000
—
FL
Enumeration date
05/23/2005
Last updated
03/07/2023
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