Provider Demographics
NPI:1740215649
Name:NGUYEN, PHUC X (MD)
Entity Type:Individual
Prefix:
First Name:PHUC
Middle Name:X
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 1:9105 N WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-1030
Mailing Address - Country:US
Mailing Address - Phone:713-633-2020
Mailing Address - Fax:713-636-7193
Practice Address - Street 1:9105 N WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-1030
Practice Address - Country:US
Practice Address - Phone:713-633-2020
Practice Address - Fax:713-636-7193
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164953501Medicaid
TX8G3605OtherBCBS
TX8G3605OtherBCBS
TX164953501Medicaid
TX8B7642Medicare PIN