Provider Demographics
NPI:1609945690
Name:NGUYEN, BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
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:PO BOX 630332
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0117
Mailing Address - Country:US
Mailing Address - Phone:972-889-1688
Mailing Address - Fax:972-889-1106
Practice Address - Street 1:375 MUNICIPAL DR
Practice Address - Street 2:SUITE 144
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3559
Practice Address - Country:US
Practice Address - Phone:972-889-1688
Practice Address - Fax:972-889-1106
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6490208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
H43846Medicare UPIN
TX8D8619Medicare PIN