Provider Demographics
NPI:1871531061
Name:NGUYEN, DANIEL V (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VAN
Other - Middle Name:DUY
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:4100 EVERETT #400
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6147
Practice Address - Country:US
Practice Address - Phone:512-504-5186
Practice Address - Fax:512-504-5536
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421772207R00000X
TXM8870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199271101Medicaid
TX1871531061OtherBSBS TX
TX8X6787OtherBCBSTX
TX1871531061OtherTRICARE
TX199271104Medicaid
PA1012175160001Medicaid
TXTXB122606Medicare PIN
TX199271101Medicaid
TX199271104Medicaid
TX1871531061OtherBSBS TX
TX1871531061OtherTRICARE
PA084814UGKMedicare ID - Type Unspecified
TXP00619370Medicare PIN