Provider Demographics
NPI:1568759751
Name:REDD, TAM NGUYEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:NGUYEN
Last Name:REDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAM
Other - Middle Name:KIM
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1751 BROAD PARK CIR S STE 201
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7827
Mailing Address - Country:US
Mailing Address - Phone:817-539-2282
Mailing Address - Fax:
Practice Address - Street 1:1751 BROAD PARK CIR S STE 201
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7827
Practice Address - Country:US
Practice Address - Phone:817-539-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ17192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry