Basic Information
| Provider Information | |||||||||
| NPI: | 1396752747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | MAI | ||||||||
| MiddleName: | THANH-THUY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | BROOKE ARMY MEDICAL CENTER, MCHE-QD (CREDENTIALING) | ||||||||
| City: | JBSA FT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109161455 | ||||||||
| FaxNumber: | 2109163585 | ||||||||
| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR | ||||||||
| Address2: | BROOKE ARMY MEDICAL CENTER, MCHE-QD (CREDENTIALING) | ||||||||
| City: | JBSA FT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109161455 | ||||||||
| FaxNumber: | 2109163585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 87535 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N2687 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | N2687 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208000000X | 87535 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0210X | N2687 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
No ID Information.