Healthcare Provider Details

I. General information

NPI: 1316263106
Provider Name (Legal Business Name): TOMMY TIEN NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S UTICA AVE SUITE 460
TULSA OK
74104-4000
US

IV. Provider business mailing address

1145 S UTICA AVE SUITE 460
TULSA OK
74104-4000
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-5749
  • Fax: 918-579-5762
Mailing address:
  • Phone: 918-579-5749
  • Fax: 918-579-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number27743
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: