Provider Demographics
NPI:1891713772
Name:NGUYEN, ADAM THANH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1320
Mailing Address - Country:US
Mailing Address - Phone:806-747-4467
Mailing Address - Fax:806-788-1708
Practice Address - Street 1:3702 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1320
Practice Address - Country:US
Practice Address - Phone:806-747-4467
Practice Address - Fax:806-788-1708
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1827213ES0103X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6166Medicare PIN