Provider Demographics
NPI:1780776435
Name:ELANGWE, PHILIP DUNN (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DUNN
Last Name:ELANGWE
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 1:2420 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4164
Mailing Address - Country:US
Mailing Address - Phone:479-782-0244
Mailing Address - Fax:479-709-7053
Practice Address - Street 1:2420 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4164
Practice Address - Country:US
Practice Address - Phone:479-782-0244
Practice Address - Fax:479-782-0267
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE5047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200169740AMedicaid
AR172829001Medicaid
AR5H181Medicare PIN