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NPI Code Detail

MEDICARE: DR. BAO-TRAM XUAN NGUYEN MD

MEDICARE: DR. BAO-TRAM XUAN NGUYEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician212931MA
22085N0700XNeuroradiology PhysicianM4393TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2J27632OTHERMABCBS MA
3469348OTHERMATUFTS HEALTH PLAN

General Provider Information

NPI Number : 1013991447
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BAO-TRAM XUAN NGUYEN MD
Provider Business Mailing Address
First Line : 1820 PRESTON PARK BLVD
Second Line : STE 1825
City : PLANO
State : TX
Zip : 75093-3656
Country : US
Telephone Number : 972-867-7862
Fax Number :
Provider Business Practice Location Address
First Line : 3901 W 15TH ST
Second Line :
City : PLANO
State : TX
Zip : 75075-7738
Country : US
Telephone Number : 972-596-6800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 10/18/2022

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