Provider Demographics
NPI:1891879011
Name:NGUYEN, LUAT TIEN (MD)
Entity Type:Individual
Prefix:
First Name:LUAT
Middle Name:TIEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 RITA LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-4573
Mailing Address - Country:US
Mailing Address - Phone:817-375-1400
Mailing Address - Fax:817-701-1979
Practice Address - Street 1:501 RITA LN
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4573
Practice Address - Country:US
Practice Address - Phone:817-375-1400
Practice Address - Fax:817-701-1979
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2709207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115965904Medicaid
TX115965904Medicaid
TXF39533Medicare UPIN