Provider Demographics
NPI:1063271211
Name:NDUGBA, STANLEY CHINAENYE (MD,MS)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:CHINAENYE
Last Name:NDUGBA
Suffix:
Gender:M
Credentials:MD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E LIMBERLOST DR APT 2038
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-2885
Mailing Address - Country:US
Mailing Address - Phone:817-229-6785
Mailing Address - Fax:
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3529
Practice Address - Country:US
Practice Address - Phone:520-469-8405
Practice Address - Fax:520-742-4369
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program