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General NPI Number Information
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NPI Number | 1831389063
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Entity Type | Individual
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Provider Name | PHONG TIEN NGUYEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 710 E 6TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4655
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Country | US
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Telephone | 254-245-9175
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11538
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City | KILLEEN
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State | TX
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Zip | 76547-1538
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Country | US
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Telephone | 254-245-9175
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | OS015620
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | OS015620
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | Q9695
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | Q9695
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License Number State | TX
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