Provider Demographics
NPI:1457675126
Name:NGUYEN, VU THAI (DPM)
Entity Type:Individual
Prefix:
First Name:VU
Middle Name:THAI
Last Name:NGUYEN
Suffix:
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 1:2915 E BASELINE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2427
Mailing Address - Country:US
Mailing Address - Phone:480-962-4281
Mailing Address - Fax:480-962-1211
Practice Address - Street 1:2915 E BASELINE RD STE 103
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2427
Practice Address - Country:US
Practice Address - Phone:804-962-4281
Practice Address - Fax:480-962-1211
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery