Healthcare Provider Details

I. General information

NPI: 1891713772
Provider Name (Legal Business Name): ADAM THANH NGUYEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 22ND PL
LUBBOCK TX
79410-1320
US

IV. Provider business mailing address

3702 22ND PL
LUBBOCK TX
79410-1320
US

V. Phone/Fax

Practice location:
  • Phone: 806-747-4467
  • Fax: 806-788-1708
Mailing address:
  • Phone: 806-747-4467
  • Fax: 806-788-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1827
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number1827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: