MEDICARE: DR. CO H 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	JO157	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	:	1780634394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CO H NGUYEN M.D

Provider Business Mailing Address
First Line	:	500 MEDICAL CENTER BLVD.
Second Line	:	#330
City	:	CONROE
State	:	TX
Zip	:	77304-2800
Country	:	US
Telephone Number	:	936-788-1659
Fax Number	:	936-788-1670

Provider Business Practice Location Address
First Line	:	500 MEDICAL CENTER BLVD.
Second Line	:	#330
City	:	CONROE
State	:	TX
Zip	:	77304-2800
Country	:	US
Telephone Number	:	936-788-1659
Fax Number	:	936-788-1670

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/19/2011

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