Provider Demographics
NPI:1184941379
Name:GBEGNON, AKPENE (MD)
Entity type:Individual
Prefix:
First Name:AKPENE
Middle Name:
Last Name:GBEGNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S 1ST ST
Mailing Address - Street 2:STE F&G
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3789
Mailing Address - Country:US
Mailing Address - Phone:626-457-6333
Mailing Address - Fax:
Practice Address - Street 1:1020 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1729
Practice Address - Country:US
Practice Address - Phone:570-753-8077
Practice Address - Fax:570-753-8453
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA170668208600000X
PAMD462058208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery