Provider Demographics
NPI:1184630451
Name:DUONG, MAI X (MD)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:X
Last Name:DUONG
Suffix:
Gender:F
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 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-421-4489
Practice Address - Street 1:1807 W SLAUGHTER LN
Practice Address - Street 2:#490
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6208
Practice Address - Country:US
Practice Address - Phone:512-282-8967
Practice Address - Fax:512-292-5141
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9871208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046664101Medicaid
TX046664102Medicaid
TX046664103Medicaid
TX046664104Medicaid
TX88591JMedicare PIN
TX046664102Medicaid
TXTXB119398Medicare PIN
TX046664104Medicaid
TX046664103Medicaid