Provider Demographics
NPI:1295067106
Name:NDOKAMA, FIDANIS (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:FIDANIS
Middle Name:
Last Name:NDOKAMA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 SW FRWY
Mailing Address - Street 2:SUITE 640
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-484-5105
Mailing Address - Fax:713-988-9550
Practice Address - Street 1:28455 TOMBALL PARKWAY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-290-8188
Practice Address - Fax:281-290-8288
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
TXPA06663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213636801Medicaid