MEDICARE: DR. VUONG BA MAI D.O.

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
1	207Q00000X	Family Medicine Physician	P3764	TX
2	207Q00000X	Family Medicine Physician	5147	OK

General Provider Information

NPI Number	:	1073829560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VUONG BA MAI D.O.

Provider Business Mailing Address
First Line	:	9016 QUARTER HORSE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3568
Country	:	US
Telephone Number	:	817-768-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	9016 QUARTER HORSE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-3568
Country	:	US
Telephone Number	:	817-768-7772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	07/26/2016

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