MEDICARE: STAFFORD MEDICAL & MED SPA, PLLC

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

General Provider Information

NPI Number	:	1316801863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAFFORD MEDICAL & MED SPA, PLLC

Provider Business Mailing Address
First Line	:	4807 SUGAR GROVE BLVD STE 201
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-2653
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4807 SUGAR GROVE BLVD STE 201
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-2653
Country	:	US
Telephone Number	:	901-550-9635
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TUAN ANH NGOC NGUYEN
Credential	:	MD
Telephone Number	:	901-438-5011

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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