Provider Demographics
NPI:1841416765
Name:DR. TRUNG NGUYEN LE, MDPA
Entity Type:Organization
Organization Name:DR. TRUNG NGUYEN LE, MDPA
Other - Org Name:DR. TONY LE, M.D.P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:NGUYEN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-426-6930
Mailing Address - Street 1:2410 ELLA BLVD.
Mailing Address - Street 2:STE. #A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2710
Mailing Address - Country:US
Mailing Address - Phone:713-426-6930
Mailing Address - Fax:713-426-6983
Practice Address - Street 1:2410 ELLA BLVD.
Practice Address - Street 2:STE. #A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2710
Practice Address - Country:US
Practice Address - Phone:713-426-6930
Practice Address - Fax:713-426-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00842VMedicare PIN
TXF12477Medicare UPIN