Provider Demographics
NPI:1427155829
Name:NGUYEN, TRI T (MD)
Entity type:Individual
Prefix:
First Name:TRI
Middle Name:T
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 1:17051 NORTH DALLAS PARKWAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001
Mailing Address - Country:US
Mailing Address - Phone:972-733-3090
Mailing Address - Fax:972-733-4565
Practice Address - Street 1:17051 NORTH DALLAS PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001
Practice Address - Country:US
Practice Address - Phone:972-733-3090
Practice Address - Fax:972-733-4565
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168704801Medicaid
TX8C1952Medicare ID - Type Unspecified
TXH45974Medicare UPIN