Healthcare Provider Details

I. General information

NPI: 1891436713
Provider Name (Legal Business Name): BASIL NJEI NDUMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 MOON DANCE CT
CONROE TX
77304-2240
US

IV. Provider business mailing address

3301 MATLOCK RD
ARLINGTON TX
76015-2908
US

V. Phone/Fax

Practice location:
  • Phone: 469-267-1172
  • Fax: 925-420-9901
Mailing address:
  • Phone: 682-509-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberV6655
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV6655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: