Provider Demographics
NPI:1295265593
Name:NGUYEN, ELIZABETH TIEN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TIEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 STATE HWY 47
Mailing Address - Street 2:STE 3115
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807
Mailing Address - Country:US
Mailing Address - Phone:979-436-9703
Mailing Address - Fax:
Practice Address - Street 1:3121 UNIVERSITY DR E STE 100
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3499
Practice Address - Country:US
Practice Address - Phone:799-776-0169
Practice Address - Fax:799-776-1342
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144828208000000X
TXT9197208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2J4411OtherMEDICARE PTAN
FL105940200Medicaid