Provider Demographics
NPI:1407876626
Name:TRUONG, NGHIA D (MD)
Entity Type:Individual
Prefix:MR
First Name:NGHIA
Middle Name:D
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:901 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1947
Mailing Address - Country:US
Mailing Address - Phone:903-596-3651
Mailing Address - Fax:903-594-2038
Practice Address - Street 1:1000 E FIFTH STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3362
Practice Address - Country:US
Practice Address - Phone:903-596-3500
Practice Address - Fax:903-596-3536
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89Z476OtherBLUE CROSS
TX110148815OtherRAILROAD MEDICARE
TX132536704Medicaid
TX89Z476Medicare UPIN
TX132536704Medicaid
TX89Z476OtherBLUE CROSS
TX110148815OtherRAILROAD MEDICARE