Healthcare Provider Details

I. General information

NPI: 1922209675
Provider Name (Legal Business Name): QUANG THANH NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 SW 34TH CIR SUITE 200
OCALA FL
34474-6616
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-7575
  • Fax: 352-401-7577
Mailing address:
  • Phone: 352-373-6338
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME109477
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME109477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: