Provider Demographics
NPI:1841227402
Name:NGUYEN, PHUONG T (MD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1776 WOODSTEAD CT STE 208
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1480
Mailing Address - Country:US
Mailing Address - Phone:877-749-7428
Mailing Address - Fax:281-724-3100
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8205
Practice Address - Fax:314-768-5315
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8G80208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO250004623OtherRR MEDICARE
MO202403606Medicaid
MO250004623OtherRR MEDICARE