Provider Demographics
NPI:1063471589
Name:NGANDO, GEORGE E (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:NGANDO
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:PO BOX 10583
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-0583
Mailing Address - Country:US
Mailing Address - Phone:251-435-2646
Mailing Address - Fax:251-435-6478
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:MOBILE EMERGENCY GROUP
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-435-2646
Practice Address - Fax:251-435-6478
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.26585207P00000X, 207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-49856OtherBCBS
AL009936017Medicaid
AL515-36030OtherBCBS
AL009936016Medicaid
AL009938358Medicaid
AL009935237Medicaid
AL009938357Medicaid
AL515-36029OtherBCBS
AL0099636018Medicaid
AL051531467OtherBLUE CROSS BLUE SHIELD
AK1063471589OtherTRICARE SOUTH
AL515-32812OtherBCBS
AL515-33204OtherBCBS
AL515-33205OtherBCBS
AL009935237Medicaid
ALP00332704Medicare PIN
AL009938357Medicaid
AL009936017Medicaid
AL051556963Medicare PIN