Provider Demographics
NPI:1477895787
Name:NGUYEN, NAM HOANG (MD)
Entity Type:Individual
Prefix:DR
First Name:NAM
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 STARLIGHT CT
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-1100
Mailing Address - Country:US
Mailing Address - Phone:817-691-3615
Mailing Address - Fax:
Practice Address - Street 1:3010 STARLIGHT CT
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-1100
Practice Address - Country:US
Practice Address - Phone:817-691-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFN6103547OtherDEA NUMBER