Provider Demographics
NPI:1962792036
Name:NGOBIA, ANNE W (DO)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:W
Last Name:NGOBIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742091
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2091
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-471-0700
Practice Address - Street 1:3411 PRESTON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9010
Practice Address - Country:US
Practice Address - Phone:214-618-3920
Practice Address - Fax:214-618-3921
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0798208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program