1750374542 NPI number — DR. PAMELA PHUONG NGUYEN MD

Table of content: DR. PAMELA PHUONG NGUYEN MD (NPI 1750374542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750374542 NPI number — DR. PAMELA PHUONG NGUYEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
PAMELA
Provider Middle Name:
PHUONG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
PAMELA
Provider Other Middle Name:
PHUONG
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1750374542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 HEIGHTS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77007-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-529-3597
Provider Business Mailing Address Fax Number:
713-529-9169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 HEIGHTS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77007-3729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-529-3597
Provider Business Practice Location Address Fax Number:
713-529-9169
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  L2502 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080591302 . This is a "TAMG GROUP THSTEPS NUMB" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J6546 . This is a "TAMG MEDICARE INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 187050301 . This is a "TAMG INDIVIDUAL MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 187050301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00438N . This is a "TAMG BCBS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00438N . This is a "TAMG MEDICARE GROUP NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080591301 . This is a "TAMG GROUP MEDICAID NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8H1985 . This is a "TAMG BCBS INDIVIDUAL NUMB" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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