Provider Demographics
NPI:1104828854
Name:NGUYEN, LUAT Q (MD)
Entity type:Individual
Prefix:
First Name:LUAT
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 MATLOCK RD
Mailing Address - Street 2:307
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2910
Mailing Address - Country:US
Mailing Address - Phone:817-468-3131
Mailing Address - Fax:817-468-8936
Practice Address - Street 1:3132 MATLOCK RD
Practice Address - Street 2:307
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2910
Practice Address - Country:US
Practice Address - Phone:817-468-3131
Practice Address - Fax:817-468-8936
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-11-14
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TXF6191207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00KT82Medicare ID - Type Unspecified
TXC19871Medicare UPIN