Provider Demographics
NPI:1861450769
Name:NGUYEN, BINH DUC (DO)
Entity Type:Individual
Prefix:
First Name:BINH
Middle Name:DUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 OAKLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-1123
Mailing Address - Country:US
Mailing Address - Phone:817-457-3853
Mailing Address - Fax:817-457-2794
Practice Address - Street 1:1127 OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-1123
Practice Address - Country:US
Practice Address - Phone:817-457-3853
Practice Address - Fax:817-457-2794
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153067701Medicaid
TX153067701Medicaid
TXTXB163453Medicare PIN
TXTXB163456Medicare PIN
TXH65478Medicare UPIN
TXTXB163464Medicare PIN