Provider Demographics
NPI:1447498746
Name:NGUYEN, JIM (PA-C)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13802 CENTERFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6044
Mailing Address - Country:US
Mailing Address - Phone:281-737-0999
Mailing Address - Fax:
Practice Address - Street 1:13802 CENTERFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6044
Practice Address - Country:US
Practice Address - Phone:281-737-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20097363AM0700X
TXPA01648363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01186474OtherRR MEDICARE
TXP01258270OtherMEDICARE RR
TX218712203Medicaid
TX1447498746OtherBLUE CROSS BLUE SHIELD
TX8408NDOtherBLUE CROSS BLUE SHIELD
TX877N87OtherBLUE CROSS BLUE SHIELD
TX218712202Medicaid
TXP01186474OtherRR MEDICARE
TX877N87OtherBLUE CROSS BLUE SHIELD
TX218712202Medicaid