Provider Demographics
NPI:1083015143
Name:TUE DUC NGUYEN MD PA
Entity Type:Organization
Organization Name:TUE DUC NGUYEN MD PA
Other - Org Name:NORTHSIDE PRIMARY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TUE
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-380-2580
Mailing Address - Street 1:6219 IRVINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-5951
Mailing Address - Country:US
Mailing Address - Phone:832-380-2580
Mailing Address - Fax:832-380-2583
Practice Address - Street 1:6219 IRVINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-5951
Practice Address - Country:US
Practice Address - Phone:832-380-2580
Practice Address - Fax:832-380-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1972207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG1972OtherTEXAS MEDICAL LICENSE