Basic Information
| Provider Information | |||||||||
| NPI: | 1366547150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | QUYET TU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 MARYLAND WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153775600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2801 FRANCISCAN DR | ||||||||
| Address2: | |||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778022544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797765967 | ||||||||
| FaxNumber: | 9797744849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 12/15/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | K3807 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | G80554 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00466544 | 01 | TX | RR MEDICARE | OTHER | 1133860-05 | 05 | TX | MEDICAID | 8V4242 | 01 | TX | BCBS TX | OTHER | 1366547150 | 01 | TX | SCOTT & WHITE HEALTH PLAN | OTHER |