1760436182 NPI number — NELSON ATEMBE TAJONG MD

Table of content: NELSON ATEMBE TAJONG MD (NPI 1760436182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760436182 NPI number — NELSON ATEMBE TAJONG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAJONG
Provider First Name:
NELSON
Provider Middle Name:
ATEMBE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760436182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
690S LOOP 336 W 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77304-3322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-828-3962
Provider Business Mailing Address Fax Number:
936-828-3967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
690S LOOP 336 W
Provider Second Line Business Practice Location Address:
STE 215
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-828-3962
Provider Business Practice Location Address Fax Number:
936-828-3967
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  M3761 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00J21A . This is a "GROUP MEDICARE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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