Northeast Tarrant Dermatology, Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

NORTHEAST TARRANT DERMATOLOGY, INC

Practice address

1733 Precinct Line Rd
Hurst, TX 76054-3131

Phone

(817) 281-7546

Fax

(817) 788-0115

NPI assigned

Apr 23, 2007

Last updated

Jan 11, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tho Q Nguyen, MDNPI 1861462020

Title

Owner

Phone

(817) 281-7546

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tho Quoc Nguyen, M.D.

  • Procedural Dermatology Physician
  • Hurst, TX
  • NPI 1861462020
  Medicare reassignment Care Compare group NPD Authorized official
• Alice Wuu, MD

  • Student in an Organized Health Care Education/Training Program
  • Fort Worth, TX
  • NPI 1245557347
  Medicare reassignment Care Compare group NPD
• Stacy Beaty, MD

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1669499638

  TX

  Medicare reassignment Care Compare group NPD
• Douglas R Farris, M.D.

  • Procedural Dermatology Physician
  • Hurst, TX
  • NPI 1073593745
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357862400000",
    "number": "1235357666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1733 PRECINCT LINE ROAD",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760543131",
            "telephone_number": "817-281-7546",
            "fax_number": "817-788-0115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1733 PRECINCT LINE RD",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760543131",
            "telephone_number": "817-281-7546",
            "fax_number": "817-788-0115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST TARRANT DERMATOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2013-01-11",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "THO",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-281-7546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• North Texas Family Care, PLLC
• Jerome Douglas Novotny Jr., M.D.
• Michaela Sydney Nowlin, CCC/SLP
• Noxi Medical
• Jana Null, M.ED., LPC, RPT
• Areli Nunez, PTA

• Dermatology Physician in Hurst, TX
• Providers in Hurst, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.