=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962931766
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUOC-BAO DUY NGUYEN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2017
-----------------------------------------------------
Last Update Date | 06/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 W ANDERSON LN STE 403
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78757-1153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-786-3498
-----------------------------------------------------
Fax | 512-243-7236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4197 WOODLANDS PKWY
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34685-3493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-333-1512
-----------------------------------------------------
Fax | 813-333-1561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | R9527
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ND0101X
-----------------------------------------------------
Taxonomy Name | MOHS-Micrographic Surgery Physician
-----------------------------------------------------
License Number | R9527
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------