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General NPI Number Information
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NPI Number | 1861848061
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Entity Type | Individual
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Provider Name | BAO XUAN NGUYEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 703 E MARSHALL AVE STE 5007
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City | LONGVIEW
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State | TX
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Zip | 75601-5554
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Country | US
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Telephone | 903-315-4882
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Fax |
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Provider Business Mailing Address
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Address Line | 703 E MARSHALL AVE STE 5007
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City | LONGVIEW
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State | TX
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Zip | 75601-5554
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Country | US
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Telephone | 903-315-4500
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Fax | 903-502-6086
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 15145
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | T4808
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | T4808
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 20A19650
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License Number State | CA
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