Healthcare Provider Details

I. General information

NPI: 1063040889
Provider Name (Legal Business Name): DOAN V. NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STATE ROUTE 664 N
LOGAN OH
43138-8541
US

IV. Provider business mailing address

238 S CONGRESS ST
RUSHVILLE IL
62681-1465
US

V. Phone/Fax

Practice location:
  • Phone: 740-380-8000
  • Fax:
Mailing address:
  • Phone: 217-322-4321
  • Fax: 217-322-2546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036166902
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75064
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35C.000952
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: