Provider Demographics
NPI:1093940298
Name:TO, BAO NGOC (MD)
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:NGOC
Last Name:TO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2001 LAUREL AVE # N304
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-766-6870
Mailing Address - Fax:865-766-0133
Practice Address - Street 1:9111 WINKBOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-1560
Practice Address - Country:US
Practice Address - Phone:865-766-6870
Practice Address - Fax:865-766-0133
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2023-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA82593207U00000X
TXM96992085R0202X
TN681662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280139101Medicaid
TX8CU599OtherBCBS
TX8CU599OtherBCBS