Provider Demographics
NPI:1114108362
Name:TA VAN NGUYEN, M.D.
Entity Type:Organization
Organization Name:TA VAN NGUYEN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TA VAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-698-4221
Mailing Address - Street 1:1250 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-4233
Mailing Address - Country:US
Mailing Address - Phone:325-698-4221
Mailing Address - Fax:325-698-6951
Practice Address - Street 1:1250 NOTTINGHAM RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-4233
Practice Address - Country:US
Practice Address - Phone:325-698-4221
Practice Address - Fax:325-698-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF28252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RE03OtherBCBS
TXC19873Medicare UPIN
TX00RE03OtherBCBS