MEDICARE: LUCI THAO NGUYEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	K3358	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174662886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCI THAO NGUYEN M.D.

Provider Business Mailing Address
First Line	:	115 MEDICAL DR
Second Line	:	SUITE 104
City	:	VICTORIA
State	:	TX
Zip	:	77904-3102
Country	:	US
Telephone Number	:	361-578-7703
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 MEDICAL DR
Second Line	:	SUITE 104
City	:	VICTORIA
State	:	TX
Zip	:	77904-3102
Country	:	US
Telephone Number	:	361-578-7703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	06/23/2010

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