Provider Demographics
NPI:1023024304
Name:QUACH, MINH TAN (DO)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:TAN
Last Name:QUACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 PRESTON PARK BLVD
Mailing Address - Street 2:APT # 123
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5171
Mailing Address - Country:US
Mailing Address - Phone:248-910-9660
Mailing Address - Fax:
Practice Address - Street 1:2300 MARIE CURIE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5706
Practice Address - Country:US
Practice Address - Phone:972-272-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3364207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3364OtherOSTEOPATHIC PHYSICIANS