Provider Demographics
NPI:1639106107
Name:NGUYEN, TAN DUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:DUONG
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 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8125
Mailing Address - Fax:956-362-8135
Practice Address - Street 1:1100 E DOVE AVE STE 402
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4684
Practice Address - Country:US
Practice Address - Phone:956-362-8125
Practice Address - Fax:956-362-8135
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLO455207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043741006Medicaid
TX452967YNG9Medicare PIN