Provider Demographics
NPI:1063694909
Name:TRANG THU NGUYEN, DPM, PA
Entity type:Organization
Organization Name:TRANG THU NGUYEN, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:THU
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-231-3122
Mailing Address - Street 1:100 S COTTONWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5705
Mailing Address - Country:US
Mailing Address - Phone:972-231-3122
Mailing Address - Fax:972-231-2021
Practice Address - Street 1:100 S COTTONWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5705
Practice Address - Country:US
Practice Address - Phone:972-231-3122
Practice Address - Fax:972-231-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1688213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173733001Medicaid
TX0054QWOtherBLUE SHIELD
TX0054QWOtherBLUE SHIELD
TX5481010001Medicare NSC