Provider Demographics
NPI:1114035383
Name:HUYNH, BOBBY (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:HUYNH
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:PO BOX 831867
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-1867
Mailing Address - Country:US
Mailing Address - Phone:972-889-1688
Mailing Address - Fax:972-889-1106
Practice Address - Street 1:375 MUNICIPAL DR
Practice Address - Street 2:SUITE 144
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3561
Practice Address - Country:US
Practice Address - Phone:972-889-1688
Practice Address - Fax:972-889-1106
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4229208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
8B7060OtherBLUE CROSS BLUE SHIELD
TX119088604Medicaid
TX6440820001Medicare NSC
TX119088604Medicaid
F69053Medicare UPIN