Provider Demographics
NPI:1194942631
Name:NGUYEN, TRI HOAIDUC (MD)
Entity type:Individual
Prefix:
First Name:TRI
Middle Name:HOAIDUC
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 1:1140 CYPRESS STATION DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3057
Mailing Address - Country:US
Mailing Address - Phone:832-643-8592
Mailing Address - Fax:281-809-3845
Practice Address - Street 1:1140 CYPRESS STATION DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3057
Practice Address - Country:US
Practice Address - Phone:832-643-8592
Practice Address - Fax:281-809-3845
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7500207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156409801Medicaid
TX8G7801OtherBCBSTX
TXP00787618Medicare PIN
TX8L20868Medicare PIN
TX070017682Medicare PIN
TX156409801Medicaid
TX8L20869Medicare PIN
G72404Medicare UPIN