Healthcare Provider Details

I. General information

NPI: 1750567921
Provider Name (Legal Business Name): PATRICK NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 HIGHWAY 151 PLAZA 1 - SUITE 100
SAN ANTONIO TX
78251-4498
US

IV. Provider business mailing address

11212 HIGHWAY 151 STE 100
SAN ANTONIO TX
78251-4500
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9900
  • Fax: 210-450-9901
Mailing address:
  • Phone: 210-450-9900
  • Fax: 210-450-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN1019
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: