Healthcare Provider Details

I. General information

NPI: 1649619685
Provider Name (Legal Business Name): ANTHONY NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 N NEVADA AVE
COLORADO SPRINGS CO
80907-5302
US

IV. Provider business mailing address

5803 LOCKHEED AVE STE 200
LOVELAND CO
80538-7027
US

V. Phone/Fax

Practice location:
  • Phone: 909-919-6183
  • Fax:
Mailing address:
  • Phone: 970-221-9451
  • Fax: 855-856-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberDR.0061822
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: