Healthcare Provider Details

I. General information

NPI: 1659661924
Provider Name (Legal Business Name): MARIE NGUYEN DIBRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 GAYLORD PKWY # 1190
FRISCO TX
75034-9416
US

IV. Provider business mailing address

3800 GAYLORD PKWY # 1190
FRISCO TX
75034-9416
US

V. Phone/Fax

Practice location:
  • Phone: 184-440-9465
  • Fax: 214-614-4277
Mailing address:
  • Phone: 844-409-4657
  • Fax: 214-614-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME120010
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME120010
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberS5360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: