Provider Demographics
NPI:1245222629
Name:LE, DZUNG V (DO)
Entity Type:Individual
Prefix:DR
First Name:DZUNG
Middle Name:V
Last Name:LE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SE LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-5863
Mailing Address - Country:US
Mailing Address - Phone:817-730-0004
Mailing Address - Fax:817-730-0601
Practice Address - Street 1:2201 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5863
Practice Address - Country:US
Practice Address - Phone:817-730-0004
Practice Address - Fax:817-730-0601
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159083802Medicaid
TXH58159Medicare UPIN