MEDICARE: JULIE NGUYEN MD

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	207N00000X	Dermatology Physician	P8959	TX

General Provider Information

NPI Number	:	1548581564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE NGUYEN MD

Provider Business Mailing Address
First Line	:	PO BOX 92424
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-0104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4949 GOLDEN TRIANGLE BLVD STE 611
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4456
Country	:	US
Telephone Number	:	817-898-2188
Fax Number	:	817-439-6055

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

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	08/26/2024

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