Provider Demographics
NPI:1245640192
Name:GEGBE, NANCY E (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:GEGBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:E
Other - Last Name:GEGBE CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7300 ELDORADO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7896
Mailing Address - Country:US
Mailing Address - Phone:214-964-0304
Mailing Address - Fax:
Practice Address - Street 1:7300 ELDORADO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7896
Practice Address - Country:US
Practice Address - Phone:214-964-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4226207Q00000X
ARE-9473207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX376846701Medicaid
TXP01912533OtherMEDICARE RAIL ROAD
TX75-2616977-121OtherTRICARE