Edge-MD Haltom City, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

N0318 Issued in TX

Legal business name

EDGE-MD HALTOM CITY, PLLC

Practice address

3101 Denton Hwy
Suite 100
Haltom City, TX 76117-3706

Phone

(817) 831-6500

Fax

(817) 831-0775

NPI assigned

Oct 30, 2014

Organization subpart

No

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

Authorized official

Name

Nathan P Nguyen, MD

Title

MD/Owner

Phone

(979) 532-2000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1457756603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2022 REGIONAL MEDICAL DR",
            "address_2": "SUITE 1315",
            "city": "WHARTON",
            "state": "TX",
            "postal_code": "774887231",
            "telephone_number": "979-532-2000",
            "fax_number": "979-532-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 DENTON HWY",
            "address_2": "SUITE 100",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "761173706",
            "telephone_number": "817-831-6500",
            "fax_number": "817-831-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGE-MD HALTOM CITY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "979-532-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N0318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Haltom City, TX
• Providers in Haltom City, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.