Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC9214 | TX |
NPI | 1104025824 |
---|---|
Provider Name | Dr. Phuong Thanh Tieu |
First Address | Euless, TX 76039-3878 |
Second Address | Arlington, TX 76014-1768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 26/08/2008 |