Provider Demographics
NPI:1982688586
Name:INYANG, EMMANUEL E (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:E
Last Name:INYANG
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N WESTMORELAND RD
Practice Address - Street 2:DEHARO-SALDIVAR HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1656
Practice Address - Country:US
Practice Address - Phone:214-266-0500
Practice Address - Fax:214-266-0554
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140973206Medicaid
TX140973220Medicaid
TX140973210Medicaid
TX140973205Medicaid
TX140973216Medicaid
TX140973203Medicaid
TX140973202Medicaid
TX140973214Medicaid
TX140973217Medicaid
TX8U7229OtherBLUE CROSS BLUE SHIELD
TX140973208Medicaid
TX140973212Medicaid
TX140973218Medicaid
TX140973220Medicaid
TX140973206Medicaid