Provider Demographics
NPI:1851620892
Name:ALLIANCE DERMATOLOGY, PC
Entity Type:Organization
Organization Name:ALLIANCE DERMATOLOGY, PC
Other - Org Name:TRI M. NGUYEN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TRI
Authorized Official - Middle Name:M
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-200-7498
Mailing Address - Street 1:5425 MATLOCK RD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1557
Mailing Address - Country:US
Mailing Address - Phone:817-200-7498
Mailing Address - Fax:
Practice Address - Street 1:5425 MATLOCK RD
Practice Address - Street 2:SUITE # 102
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1557
Practice Address - Country:US
Practice Address - Phone:817-200-7498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1267261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
I49723Medicare UPIN