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General NPI Number Information
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NPI Number | 1760126528
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Entity Type | Individual
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Provider Name | NAM HOAI TRAN NGUYEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 300 TUSKEGEE BLVD
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City | DOVER
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State | DE
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Zip | 19902-5003
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Country | US
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Telephone | 302-677-6527
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 YORKTOWN DR
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City | ARLINGTON
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State | TX
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Zip | 76014-2535
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Country | US
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Telephone | 817-903-1377
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15751
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License Number State | TX
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