Provider Demographics
NPI:1629648308
Name:EGBE BESSONG TABOT, ANTOINE (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:EGBE BESSONG TABOT
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 1:3602 MYSTIC BAY CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7604
Mailing Address - Country:US
Mailing Address - Phone:737-618-0136
Mailing Address - Fax:
Practice Address - Street 1:104 7TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4853
Practice Address - Country:US
Practice Address - Phone:979-245-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4351047559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine