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General NPI Number Information
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NPI Number | 1336710136
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Entity Type | Individual
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Provider Name | PAUL NAM PHONG NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 1119 W RANDOL MILL RD STE 107
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City | ARLINGTON
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State | TX
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Zip | 76012-6509
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Country | US
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Telephone | 817-860-2700
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Fax | 817-860-2704
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Provider Business Mailing Address
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Address Line | 1119 W RANDOL MILL RD
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City | ARLINGTON
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State | TX
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Zip | 76012-6509
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Country | US
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Telephone | 817-860-2700
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Fax | 817-860-2704
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 692165
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2021025316
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License Number State | MO
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