# EDGE-MD LAKE JUNE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720488745
- **Authorized official:** DR. NATHAN P. NGUYEN MD (OWNER/MD)
- **Authorized official phone:** (979) 532-2000

## Contact information

- **Practice address:** 6909 LAKE JUNE RD, DALLAS, TX 75217-1325
- **Practice address phone:** (214) 391-1900
- **Practice address fax:** (214) 391-1914
- **Mailing address:** 2022 REGIONAL MEDICAL DR, SUITE 1315, WHARTON, TX 77488-7231
- **Mailing address phone:** (979) 532-2000
- **Mailing address fax:** (979) 532-2008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | N0318 | TX | Yes |

## Other

- **Enumeration date:** 08/27/2014
- **Last updated:** 01/13/2015