MEDICARE: TRAM ANH 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	207Q00000X	Family Medicine Physician	Q5880	TX

General Provider Information

NPI Number	:	1619235405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAM ANH NGUYEN M.D.

Provider Business Mailing Address
First Line	:	4561 HERITAGE TRACE PKWY STE 109
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8907
Country	:	US
Telephone Number	:	682-200-0022
Fax Number	:

Provider Business Practice Location Address
First Line	:	4561 HERITAGE TRACE PKWY STE 109
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8907
Country	:	US
Telephone Number	:	682-200-0022
Fax Number	:

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

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	01/03/2018

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