Healthcare Provider Details

I. General information

NPI: 1407876626
Provider Name (Legal Business Name): NGHIA D TRUONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E FIFTH STREET SUITE 400
TYLER TX
75701-3362
US

IV. Provider business mailing address

901 TURTLE CREEK DR
TYLER TX
75701-1947
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-3500
  • Fax: 903-596-3536
Mailing address:
  • Phone: 903-596-3651
  • Fax: 903-594-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ6778
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: