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NPI Code Detail

MEDICARE: PHONG TIEN NGUYEN D.O.

MEDICARE: PHONG TIEN NGUYEN D.O.
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
1207L00000XAnesthesiology PhysicianOS015620PA
2207LP2900XPain Medicine (Anesthesiology) PhysicianOS015620PA
3207L00000XAnesthesiology PhysicianQ9695TX
4207LP2900XPain Medicine (Anesthesiology) PhysicianQ9695TX

General Provider Information

NPI Number : 1831389063
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHONG TIEN NGUYEN D.O.
Provider Business Mailing Address
First Line : PO BOX 11538
Second Line :
City : KILLEEN
State : TX
Zip : 76547-1538
Country : US
Telephone Number : 254-245-9175
Fax Number :
Provider Business Practice Location Address
First Line : 710 E 6TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-4655
Country : US
Telephone Number : 254-245-9175
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2007
Last Update Date : 11/18/2024

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Directions to “ PHONG TIEN NGUYEN D.O.” Practice Location

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