MEDICARE: TRI MINH PHUNG 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	207L00000X	Anesthesiology Physician	N8443	TX

General Provider Information

NPI Number	:	1689874190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRI MINH PHUNG MD

Provider Business Mailing Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:	DEPARTMENT OF ANESTHESIOLOGY AND PAIN MANAGEMENT
City	:	DALLAS
State	:	TX
Zip	:	75390-9068
Country	:	US
Telephone Number	:	214-648-5460
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:	DEPARTMENT OF ANESTHESIOLOGY AND PAIN MANAGEMENT
City	:	DALLAS
State	:	TX
Zip	:	75390-9068
Country	:	US
Telephone Number	:	214-648-5460
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	12/18/2012

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