Provider Demographics
NPI:1386639375
Name:NGUYEN, MAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:MAN
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8485 US HIGHWAY 64 STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4102
Mailing Address - Country:US
Mailing Address - Phone:901-377-3001
Mailing Address - Fax:901-377-3230
Practice Address - Street 1:8485 US HIGHWAY 64 STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4102
Practice Address - Country:US
Practice Address - Phone:901-377-3001
Practice Address - Fax:901-377-3230
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD12858207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3191394Medicaid
TN3191394Medicaid
F46802Medicare UPIN
TNF46802Medicare UPIN