MEDICARE: DR. THERESA HT NGUYEN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO60335864	WA
2	213EP1101X	Primary Podiatric Medicine Podiatrist	3185	TX

General Provider Information

NPI Number	:	1487959219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA HT NGUYEN DPM

Provider Business Mailing Address
First Line	:	2633 DALLAS PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4715
Country	:	US
Telephone Number	:	972-403-7733
Fax Number	:	972-403-7744

Provider Business Practice Location Address
First Line	:	2633 DALLAS PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4715
Country	:	US
Telephone Number	:	972-403-7733
Fax Number	:	972-403-7744

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

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	09/07/2023

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