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General NPI Number Information
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NPI Number | 1407077407
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Entity Type | Individual
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Provider Name | QUAN T NGUYEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 1300 W TERRELL AVE FL 2
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City | FORT WORTH
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State | TX
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Zip | 76104-2820
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Country | US
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Telephone | 817-820-4906
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Fax | 817-820-4815
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Provider Business Mailing Address
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Address Line | 1300 W TERRELL AVE FL 2
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City | FORT WORTH
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State | TX
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Zip | 76104-2820
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Country | US
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Telephone | 817-820-4906
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Fax | 817-820-4815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5101016636
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N9275
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License Number State | TX
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