Individual
DR. BRUCE IZEOKHAI OVBIAGELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., MSC
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
35357
SC
2084N0400X
Neurology Physician
A64840
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A648400
—
CA
Enumeration date
07/17/2006
Last updated
02/12/2013
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