Provider Demographics
NPI:1356819874
Name:NGUYEN, ERIC D (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3201 DUVAL RD APT 1037
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5422
Mailing Address - Country:US
Mailing Address - Phone:714-852-1977
Mailing Address - Fax:
Practice Address - Street 1:3300 BEE CAVES RD # 440
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6600
Practice Address - Country:US
Practice Address - Phone:512-910-2654
Practice Address - Fax:888-972-1912
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant