Provider Demographics
NPI:1033187299
Name:MBONU, CHARLES CHIBUNDU (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHIBUNDU
Last Name:MBONU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 7707
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505
Mailing Address - Country:US
Mailing Address - Phone:903-614-5001
Mailing Address - Fax:903-614-5077
Practice Address - Street 1:2604 ST. MICHAEL DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-614-5001
Practice Address - Fax:903-614-5077
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3171207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine