Provider Demographics
NPI:1720013626
Name:NGUYEN, PHUC D (MD)
Entity Type:Individual
Prefix:
First Name:PHUC
Middle Name:D
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 1:6410 FANNIN ST STE 170
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3003
Mailing Address - Country:US
Mailing Address - Phone:832-325-6500
Mailing Address - Fax:713-512-2236
Practice Address - Street 1:6410 FANNIN ST STE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3003
Practice Address - Country:US
Practice Address - Phone:832-325-6500
Practice Address - Fax:713-512-2236
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G3607OtherBCBS
TX166148001Medicaid
TXI10260Medicare UPIN
TX166148001Medicaid