Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | M1267 | TX |
NPI | 1003952086 |
---|---|
Provider Name | Tri Minh Nguyen |
First Address | Arlington, TX 76012-4695 |
Second Address | Arlington, TX 76012-4695 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 12/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I49723 | (02) | TX |