Provider Demographics
NPI:1497374029
Name:NGUYEN, ALEXANDER MARC (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:MARC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ALEXANDER MARC
Other - Middle Name:GADDI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:MSC11 6093 1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-3737
Mailing Address - Country:US
Mailing Address - Phone:505-272-6225
Mailing Address - Fax:505-272-5184
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-3737
Practice Address - Country:US
Practice Address - Phone:505-272-6225
Practice Address - Fax:505-272-5184
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program