Provider Demographics
NPI:1336710136
Name:NGUYEN, PAUL NAM PHONG
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:NAM PHONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:NAM PHONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:1119 W RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-6509
Mailing Address - Country:US
Mailing Address - Phone:817-860-2700
Mailing Address - Fax:817-860-2704
Practice Address - Street 1:1119 W RANDOL MILL RD STE 107
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-6509
Practice Address - Country:US
Practice Address - Phone:817-860-2700
Practice Address - Fax:817-860-2704
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692165213E00000X
MO2021025316213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist