Provider Demographics
NPI:1487098570
Name:LE, THERESA VY UYEN (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:VY UYEN
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S MAIN ST
Mailing Address - Street 2:STE 240
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-4960
Mailing Address - Country:US
Mailing Address - Phone:817-912-8150
Mailing Address - Fax:
Practice Address - Street 1:620 S MAIN ST
Practice Address - Street 2:STE 240
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4960
Practice Address - Country:US
Practice Address - Phone:817-912-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine