Basic Information
| Provider Information | |||||||||
| NPI: | 1437115946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | TAM | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5865 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794085865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432898 | ||||||||
| FaxNumber: | 8067432787 | ||||||||
| Practice Location | |||||||||
| Address1: | 3502 9TH ST | ||||||||
| Address2: | STE 410 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067434115 | ||||||||
| FaxNumber: | 8067431313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | M2422 | TX | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 179081801 | 05 | TX | MEDICAID | 8A2678 | 01 | TX | BC/BS | OTHER | 146200101 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | 200074720A | 01 | OK | OK HEALTHCARE AUTHORITY | OTHER | 202004124 | 05 | NM | MEDICAID | 8M0737 | 01 | TX | HMO BLUE | OTHER | BN9342875 | 01 | TX | DEA | OTHER | 10142612 | 01 | TX | DPS | OTHER | 34920714 | 05 | NM | MEDICAID | 146200102 | 05 | TX | MEDICAID | 202004124 | 01 | NM | PRESBYTERIAN COMMERCIAL | OTHER |