Healthcare Provider Details

I. General information

NPI: 1144463290
Provider Name (Legal Business Name): MD24, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14780 W MOUNTAIN VIEW BLVD SUITE 110
SURPRISE AZ
85374-4799
US

IV. Provider business mailing address

14780 W MOUNTAIN VIEW BLVD SUITE 110
SURPRISE AZ
85374-4799
US

V. Phone/Fax

Practice location:
  • Phone: 623-374-7774
  • Fax: 855-420-6361
Mailing address:
  • Phone: 623-374-7774
  • Fax: 855-420-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35198
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35198
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35198
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. LINH C. NGUYEN
Title or Position: CMIO/CEO
Credential: MD, MS, MMM
Phone: 623-374-7774