Provider Demographics
NPI:1518909795
Name:ETINDI, RANSOME NJEKA (MD)
Entity Type:Individual
Prefix:
First Name:RANSOME
Middle Name:NJEKA
Last Name:ETINDI
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 1:300 SIOUX CT
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1550
Mailing Address - Country:US
Mailing Address - Phone:214-684-1227
Mailing Address - Fax:
Practice Address - Street 1:300 SIOUX COURT
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1128
Practice Address - Country:US
Practice Address - Phone:214-684-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143899603Medicaid
TX81837SOtherBCBS
TX143899604Medicaid
TX8BR073OtherBCBS
TX8F3665Medicare PIN
TX110222837Medicare PIN
TXH36714Medicare UPIN
TXP00708945Medicare PIN
TX143899604Medicaid