Provider Demographics
NPI:1235234139
Name:MCCOLM, VINCENT NGUYEN (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:NGUYEN
Last Name:MCCOLM
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 1:6750 N MACARTHUR BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2831
Mailing Address - Country:US
Mailing Address - Phone:972-373-0303
Mailing Address - Fax:972-373-8074
Practice Address - Street 1:6750 N MACARTHUR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2831
Practice Address - Country:US
Practice Address - Phone:972-373-0303
Practice Address - Fax:972-373-8074
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4337208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184929103Medicaid
TX184929102Medicaid
TX8J3036Medicare ID - Type Unspecified