Provider Demographics
NPI:1548283930
Name:ORIZU, IFEANYI SAMUEL SR (MD)
Entity type:Individual
Prefix:DR
First Name:IFEANYI
Middle Name:SAMUEL
Last Name:ORIZU
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:720 SOUTH BISHOP AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401
Mailing Address - Country:US
Mailing Address - Phone:573-364-5600
Mailing Address - Fax:573-364-9622
Practice Address - Street 1:720 SOUTH BISHOP AVENUE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401
Practice Address - Country:US
Practice Address - Phone:573-364-5600
Practice Address - Fax:573-364-9622
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000158329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204995401Medicaid
MO000094825Medicare ID - Type Unspecified
G55362Medicare UPIN