Provider Demographics
NPI:1437222858
Name:NGUYEN, TRANG THU (DPM)
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:THU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S COTTONWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5705
Mailing Address - Country:US
Mailing Address - Phone:972-231-3122
Mailing Address - Fax:972-231-2021
Practice Address - Street 1:100 S COTTONWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5705
Practice Address - Country:US
Practice Address - Phone:972-231-3122
Practice Address - Fax:972-231-2021
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1688213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0023MEOtherBLUE SHIELD
TX8AX000OtherBLUE SHIELD
TX173736301Medicaid
TXV01875Medicare UPIN
TX5481010001Medicare NSC
TX8C9382Medicare PIN