Provider Demographics
NPI:1083721559
Name:NGUYEN, VAN T IV (DPM)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:T
Last Name:NGUYEN
Suffix:IV
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 MEMORIAL PKWY SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3039
Mailing Address - Country:US
Mailing Address - Phone:256-883-2626
Mailing Address - Fax:
Practice Address - Street 1:8010 MEMORIAL PKWY SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3039
Practice Address - Country:US
Practice Address - Phone:256-883-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00177213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU67338Medicare UPIN
AL38263Medicare ID - Type Unspecified