Provider Demographics
NPI:1023012002
Name:NGUYEN, HUY LE (MD)
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:LE
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7355 N BEACH ST
Mailing Address - Street 2:SUITE 153
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1897
Mailing Address - Country:US
Mailing Address - Phone:817-984-7100
Mailing Address - Fax:817-984-7099
Practice Address - Street 1:7355 N BEACH ST
Practice Address - Street 2:SUITE 153
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1897
Practice Address - Country:US
Practice Address - Phone:817-984-7100
Practice Address - Fax:817-984-7099
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3357207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103718603Medicaid
F93839Medicare UPIN
TX103718603Medicaid
84171NMedicare PIN