Provider Demographics
NPI:1760671440
Name:HUYEN NGUYEN MD PA
Entity Type:Organization
Organization Name:HUYEN NGUYEN MD PA
Other - Org Name:ALAMO WELLNESS ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUYEN
Authorized Official - Middle Name:THI
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-599-4086
Mailing Address - Street 1:12501 JUDSON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4103
Mailing Address - Country:US
Mailing Address - Phone:210-599-4086
Mailing Address - Fax:
Practice Address - Street 1:12501 JUDSON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-4103
Practice Address - Country:US
Practice Address - Phone:210-599-4086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00047TMedicare PIN