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General NPI Number Information
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NPI Number | 1629648308
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Entity Type | Individual
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Provider Name | ANTOINE EGBE BESSONG TABOT MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 104 7TH ST
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City | BAY CITY
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State | TX
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Zip | 77414-4853
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Country | US
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Telephone | 979-245-6383
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Fax |
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Provider Business Mailing Address
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Address Line | 3602 MYSTIC BAY CT
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City | SUGAR LAND
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State | TX
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Zip | 77498-7604
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Country | US
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Telephone | 737-618-0136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4351047559
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License Number State | TX
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