Provider Demographics
NPI:1770014490
Name:FOMBUTU EPSE OKONG, KUNA TIGA (MD)
Entity Type:Individual
Prefix:
First Name:KUNA TIGA
Middle Name:
Last Name:FOMBUTU EPSE OKONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KUNA
Other - Middle Name:TIGA
Other - Last Name:OKONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9662
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-9662
Mailing Address - Country:US
Mailing Address - Phone:501-852-1363
Mailing Address - Fax:501-852-1364
Practice Address - Street 1:1700 ALTUS ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4289
Practice Address - Country:US
Practice Address - Phone:501-513-5909
Practice Address - Fax:501-513-5257
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE13400208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist