Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | N3171 | TX |
N | 111NI0900X | Internist | N3171 | TX |
Y | 207RI0200X | Infectious Disease | N3171 | TX |
NPI | 1033187299 |
---|---|
Provider Name | Charles Chibundu Mbonu |
First Address | Texarkana, TX 75505 |
Second Address | Texarkana, TX 75503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 09/12/2014 |