Provider Demographics
NPI:1528144706
Name:NGWU, SAMUEL C (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:NGWU
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2909 S HAMPTON RD
Mailing Address - Street 2:SUITE F-122
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3000
Mailing Address - Country:US
Mailing Address - Phone:214-879-8820
Mailing Address - Fax:214-879-6890
Practice Address - Street 1:2909 S HAMPTON RD
Practice Address - Street 2:SUITE F-122
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3000
Practice Address - Country:US
Practice Address - Phone:214-879-8820
Practice Address - Fax:214-879-6890
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-10-02
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Provider Licenses
StateLicense IDTaxonomies
TXK2087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00754DOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX113689703Medicaid
TXP00093034OtherRAILROAD MEDICARE
TXG43897Medicare UPIN
TX113689703Medicaid