Individual
DONATUS M. EGBONIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2000
Mailing address
PO BOX 844088, DALLAS, TX 75284-4088
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
N3018
TX
207R00000X
Internal Medicine Physician
20233
SC
207R00000X
Internal Medicine Physician
Primary
MD2018-0202
NM
207R00000X
Internal Medicine Physician
N3018
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0116367
GHI
SC
01
—
20049632
SELECT HEALTH FIRST CHOICE
SC
05
—
202337
—
SC
01
—
P00423235
RAILROAD MEDICARE
SC
Enumeration date
06/03/2006
Last updated
11/14/2024
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