Individual
AZINGALA AJUA FONDONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4215 JOE RAMSEY BLVD E, GREENVILLE, TX 75401-7852
(903) 408-5000
Mailing address
501 AIR PARK AVE, GREENVILLE, TX 75402-3000
(903) 408-5834
(903) 408-5693
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
30382
MS
207P00000X
Emergency Medicine Physician
Primary
U2199
TX
207Q00000X
Family Medicine Physician
30382
MS
207Q00000X
Family Medicine Physician
U2199
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154882702
—
TN
05
—
1154882702
—
TX
Enumeration date
03/27/2019
Last updated
09/24/2025
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