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NPI Code Detail

MEDICARE: DON V NGUYEN PA

MEDICARE: DON V NGUYEN PA
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
1363A00000XPhysician AssistantPA04872TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2PA04872OTHERTXSTATE LICENSE

General Provider Information

NPI Number : 1043221104
Entity Type Code : Individual
Provider Name (Legal Business Name) : DON V NGUYEN PA
Provider Business Mailing Address
First Line : 4504 BOAT CLUB RD
Second Line : 800
City : FORT WORTH
State : TX
Zip : 76135-7003
Country : US
Telephone Number : 817-237-4794
Fax Number : 817-237-4880
Provider Business Practice Location Address
First Line : 141 INDUSTRIAL AVE
Second Line :
City : AZLE
State : TX
Zip : 76020-2901
Country : US
Telephone Number : 817-444-3231
Fax Number : 817-444-0992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 10/18/2010

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Directions to “ DON V NGUYEN PA” Practice Location

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