Provider Demographics
NPI:1083700512
Name:NABWANGU, JAMES F (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:NABWANGU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-3450
Mailing Address - Country:US
Mailing Address - Phone:605-719-5650
Mailing Address - Fax:605-719-5655
Practice Address - Street 1:2805 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6003
Practice Address - Country:US
Practice Address - Phone:605-719-5650
Practice Address - Fax:605-719-5655
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4934207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6100783Medicaid
SD6100783Medicaid