Provider Demographics
NPI:1538350301
Name:TRUNG D. NGUYEN MD PA
Entity type:Organization
Organization Name:TRUNG D. NGUYEN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:817-921-5997
Mailing Address - Street 1:900 W MAGNOLIA AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-8517
Mailing Address - Country:US
Mailing Address - Phone:817-921-5997
Mailing Address - Fax:817-921-5998
Practice Address - Street 1:900 W MAGNOLIA AVE
Practice Address - Street 2:STE 201
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8517
Practice Address - Country:US
Practice Address - Phone:817-921-5997
Practice Address - Fax:817-921-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4391208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W213Medicare PIN