Healthcare Provider Details

I. General information

NPI: 1841238128
Provider Name (Legal Business Name): NHAT QUANG NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR SUITE 300
GRESHAM OR
97030-3721
US

IV. Provider business mailing address

831 NW COUNCIL DR SUITE 300
GRESHAM OR
97030-3721
US

V. Phone/Fax

Practice location:
  • Phone: 503-381-8100
  • Fax: 503-382-8120
Mailing address:
  • Phone: 503-382-8100
  • Fax: 503-382-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD26622
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD26622
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: