Provider Demographics
NPI:1760436182
Name:TAJONG, NELSON ATEMBE (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:ATEMBE
Last Name:TAJONG
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 1:690S LOOP 336 W 215
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3322
Mailing Address - Country:US
Mailing Address - Phone:936-828-3962
Mailing Address - Fax:936-828-3967
Practice Address - Street 1:690S LOOP 336 W
Practice Address - Street 2:STE 215
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3322
Practice Address - Country:US
Practice Address - Phone:936-828-3962
Practice Address - Fax:936-828-3967
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3761207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherGROUP MEDICARE NUMBER
TX00J21AOtherGROUP MEDICARE NUMBER
TX8L0906Medicare PIN