MEDICARE: DR. PETER V NGUYEN MD

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	207R00000X	Internal Medicine Physician	L3769	TX
2	207RN0300X	Nephrology Physician	L3769	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
2	8U1251	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1790709285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER V NGUYEN MD

Provider Business Mailing Address
First Line	:	1000 W CANNON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3029
Country	:	US
Telephone Number	:	817-877-5858
Fax Number	:	817-335-4418

Provider Business Practice Location Address
First Line	:	203 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5857
Country	:	US
Telephone Number	:	817-877-5858
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	09/02/2022

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