Provider Demographics
NPI:1336393156
Name:NATHAN NGUYEN, MD, PA
Entity Type:Organization
Organization Name:NATHAN NGUYEN, MD, PA
Other - Org Name:REGENT ADULT AND PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:PHUC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-532-2000
Mailing Address - Street 1:1403 VALHALLA DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9218
Mailing Address - Country:US
Mailing Address - Phone:979-532-2000
Mailing Address - Fax:979-532-2008
Practice Address - Street 1:1403 VALHALLA DR
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-9218
Practice Address - Country:US
Practice Address - Phone:979-532-2000
Practice Address - Fax:979-532-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2017-04-07
Deactivation Date:2009-02-03
Deactivation Code:
Reactivation Date:2010-11-16
Provider Licenses
StateLicense IDTaxonomies
TXN0318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty