Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1773 | TX |
N | 222Z00000X | Podiatrist | 1773 | TX |
Y | 224P00000X | Prosthetist | 1773 | TX |
NPI | 1275048852 |
---|---|
Provider Name | Phuoc Nguyen |
First Address | Lewisville, TX 75067-2056 |
Second Address | Plano, TX 75075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2017 |
Last Update Date | 21/05/2018 |