Provider Demographics
NPI:1609053750
Name:NGUYEN, THINH BAO (MD)
Entity Type:Individual
Prefix:
First Name:THINH
Middle Name:BAO
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 1:211 HIGHLAND CROSS DR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1733
Mailing Address - Country:US
Mailing Address - Phone:281-784-1088
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:211 HIGHLAND CROSS DR
Practice Address - Street 2:SUITE 275
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1733
Practice Address - Country:US
Practice Address - Phone:281-784-1088
Practice Address - Fax:281-784-1555
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN1020208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1609053750OtherTRICARE
TX1985814-01Medicaid
TX8BU149OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX8BU149OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX8L5984Medicare PIN