Basic Information
| Provider Information | |||||||||
| NPI: | 1407876626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUONG | ||||||||
| FirstName: | NGHIA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 TURTLE CREEK DR | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757011947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035963651 | ||||||||
| FaxNumber: | 9035942038 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E FIFTH STREET | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757013362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035963500 | ||||||||
| FaxNumber: | 9035963536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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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 | J6778 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 89Z476 | 01 | TX | BLUE CROSS | OTHER | 110148815 | 01 | TX | RAILROAD MEDICARE | OTHER | 132536704 | 05 | TX | MEDICAID |