Provider Demographics
NPI:1700063294
Name:NGANKEU, EVARISTE B
Entity type:Individual
Prefix:DR
First Name:EVARISTE
Middle Name:B
Last Name:NGANKEU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 ENGLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6721
Mailing Address - Country:US
Mailing Address - Phone:240-462-9734
Mailing Address - Fax:
Practice Address - Street 1:3227 ENGLAND PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6721
Practice Address - Country:US
Practice Address - Phone:240-462-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088464207R00000X
TXN3941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine