Provider Demographics
NPI:1811746498
Name:NDUKA, TAGBO CHARLES (MD)
Entity type:Individual
Prefix:MR
First Name:TAGBO
Middle Name:CHARLES
Last Name:NDUKA
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 1:10901 MEADOWGLEN LANE
Mailing Address - Street 2:APT 143
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042
Mailing Address - Country:US
Mailing Address - Phone:281-965-0395
Mailing Address - Fax:
Practice Address - Street 1:CHRISTUS HEALTH
Practice Address - Street 2:700 EAST MARSHALL AVENUE
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-315-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10088601390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program