Provider Demographics
NPI:1043221104
Name:NGUYEN, DON V (PA)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4504 BOAT CLUB RD
Mailing Address - Street 2:800
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-7003
Mailing Address - Country:US
Mailing Address - Phone:817-237-4794
Mailing Address - Fax:817-237-4880
Practice Address - Street 1:141 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2901
Practice Address - Country:US
Practice Address - Phone:817-444-3231
Practice Address - Fax:817-444-0992
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193476203Medicaid
TXPA04872OtherSTATE LICENSE
TX193476203Medicaid