Provider Demographics
NPI:1467137125
Name:IBEAWUCHI, MORRIS (MD)
Entity type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:
Last Name:IBEAWUCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4775
Mailing Address - Country:US
Mailing Address - Phone:307-777-7911
Mailing Address - Fax:
Practice Address - Street 1:821 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4775
Practice Address - Country:US
Practice Address - Phone:307-777-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-P122132-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine