Provider Demographics
NPI:1043469422
Name:PLEASANTON FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:PLEASANTON FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:VUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-569-3553
Mailing Address - Street 1:1240 W OAKLAWN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4300
Mailing Address - Country:US
Mailing Address - Phone:830-569-3553
Mailing Address - Fax:
Practice Address - Street 1:1240 W OAKLAWN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4300
Practice Address - Country:US
Practice Address - Phone:830-569-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QP2300X
TXL7917261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A0012Medicare PIN