Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | N9104 | TX |
NPI | 1104088848 |
---|---|
Provider Name | Dr. Luc Nguyen |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-4402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 08/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
323761201 | (05) | TX |
323761202 | MEDICAID CSHCN (01) | TX |