Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | P7947 | TX |
NPI | 1255651279 |
---|---|
Provider Name | Vinh Tuan Mai |
First Address | Grand Prairie, TX 75052-3019 |
Second Address | Irving, TX 75039-5402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 11/08/2014 |