Provider Demographics
NPI:1235247024
Name:NGUYEN, THO H (DPM)
Entity Type:Individual
Prefix:
First Name:THO
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 HICKORY PATH WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3296
Mailing Address - Country:US
Mailing Address - Phone:423-802-3239
Mailing Address - Fax:866-714-6553
Practice Address - Street 1:10409 HICKORY PATH WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3296
Practice Address - Country:US
Practice Address - Phone:423-802-3239
Practice Address - Fax:866-714-6553
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN542213E00000X
GA000777213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00703007AMedicaid
TN3353103Medicaid
GA00703007AMedicaid
GA48SCBRQMedicare ID - Type UnspecifiedGA MEDICARE
TN3353103Medicare ID - Type UnspecifiedMEDICARE TN