=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942261771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRUNG D NGUYEN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 W MAGNOLIA AVE STE. 201
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-8517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-921-5997
-----------------------------------------------------
Fax | 817-921-5998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 W MAGNOLIA AVE STE. 201
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-8517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-921-5997
-----------------------------------------------------
Fax | 817-921-5998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | J4391
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------