Provider Demographics
NPI:1053516542
Name:NGUYEN, QUANG T (DO)
Entity type:Individual
Prefix:
First Name:QUANG
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N PECOS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7364
Mailing Address - Country:US
Mailing Address - Phone:702-605-5750
Mailing Address - Fax:702-605-5751
Practice Address - Street 1:229 N PECOS RD STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7364
Practice Address - Country:US
Practice Address - Phone:702-605-5750
Practice Address - Fax:702-605-5751
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR932207RE0101X
NVDO1414207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AT3642Medicare PIN