Provider Demographics
NPI:1356337331
Name:NGUYEN, PHAN T (MD)
Entity type:Individual
Prefix:
First Name:PHAN
Middle Name:T
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 1:601 OMEGA DR STE 208
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2075
Mailing Address - Country:US
Mailing Address - Phone:682-323-7006
Mailing Address - Fax:888-720-1899
Practice Address - Street 1:601 OMEGA DR STE 208
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2075
Practice Address - Country:US
Practice Address - Phone:682-323-7006
Practice Address - Fax:888-720-1899
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1145207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145686501Medicaid
TX8253M3Medicare PIN
TX145686501Medicaid