Provider Demographics
NPI:1437128113
Name:NGUYEN, TAM T (MD)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-245-6286
Mailing Address - Fax:
Practice Address - Street 1:6111 E ARBOR AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6059
Practice Address - Country:US
Practice Address - Phone:480-981-1326
Practice Address - Fax:480-981-1445
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262762085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXPY201560Medicaid
NMG2013Medicaid
NV2018254Medicaid
NMG2013Medicaid
NV32915Medicare PIN