Provider Demographics
NPI:1598754970
Name:NGUYEN, NAM QUOC (DO)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE A 216
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4301
Mailing Address - Country:US
Mailing Address - Phone:954-725-8808
Mailing Address - Fax:954-725-8818
Practice Address - Street 1:5300 W HILLSBORO BLVD
Practice Address - Street 2:SUITE A 216
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4301
Practice Address - Country:US
Practice Address - Phone:954-725-8808
Practice Address - Fax:954-725-8818
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0008287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264678100Medicaid
H78725Medicare UPIN
FL264678100Medicaid