Provider Demographics
NPI:1063688711
Name:AMBE, RONALD WANKI NGWA (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WANKI NGWA
Last Name:AMBE
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 1:350 KINGWOOD MEDICAL DR STE 230
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6405
Mailing Address - Country:US
Mailing Address - Phone:832-732-7698
Mailing Address - Fax:281-608-7542
Practice Address - Street 1:350 KINGWOOD MEDICAL DR STE 230
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6405
Practice Address - Country:US
Practice Address - Phone:832-732-7698
Practice Address - Fax:281-608-7542
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6323208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022138700001Medicaid
PA136726HR2Medicare PIN