MEDICARE: TARRANT INTERNAL MEDICINE & PEDIATRICS, PLLC

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	208000000X	Pediatrics Physician	K3357	LA
2	207R00000X	Internal Medicine Physician	K3357	LA

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	:	1316240617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRANT INTERNAL MEDICINE & PEDIATRICS, PLLC

Provider Business Mailing Address
First Line	:	7355 N BEACH ST
Second Line	:	SUITE 153
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1897
Country	:	US
Telephone Number	:	817-881-9534
Fax Number	:

Provider Business Practice Location Address
First Line	:	7355 N BEACH ST
Second Line	:	SUITE 153
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1897
Country	:	US
Telephone Number	:	817-881-9534
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HUY NGUYEN
Credential	:	M.D.
Telephone Number	:	817-881-9534

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	03/14/2011

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