Individual
AMBESI NGWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4129
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
P9236
TX
208M00000X
Hospitalist Physician
P9236
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1F0820
MEDICARE
TX
05
—
342944108
—
TX
Enumeration date
06/03/2014
Last updated
02/21/2024
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