MEDICARE: RECONSTRUCTIVE MICROSURGERY AND LYMPHEDEMA ASSOCIATES

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	2086S0122X	Plastic and Reconstructive Surgery Physician	N5907	TX

General Provider Information

NPI Number	:	1093171761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECONSTRUCTIVE MICROSURGERY AND LYMPHEDEMA ASSOCIATES

Provider Business Mailing Address
First Line	:	7777 FOREST LN STE B216
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6810
Country	:	US
Telephone Number	:	214-613-1589
Fax Number	:	214-613-1590

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE B216
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-6810
Country	:	US
Telephone Number	:	214-613-1589
Fax Number	:	214-613-1590

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ALEXANDER T NGUYEN
Credential	:	M.D.
Telephone Number	:	214-613-1589

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	03/22/2018

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