Provider Demographics
NPI:1013901834
Name:NGUYEN, TRUNG B (MD)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:B
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 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-237-7246
Mailing Address - Fax:580-249-4152
Practice Address - Street 1:401 S 3RD ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5737
Practice Address - Country:US
Practice Address - Phone:580-237-7246
Practice Address - Fax:580-249-4152
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19294208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100223170AMedicaid
OK$$$$$$$$$-001OtherBCBS OF OKLAHOMA
OK100223170AMedicaid
OK$$$$$$$$$-003OtherBCBS OF OKLAHOMA
F99350Medicare UPIN
OKOK700180Medicare PIN
OK100223170AMedicaid
OK$$$$$$$$$-003OtherBCBS OF OKLAHOMA