Provider Demographics
NPI:1679747216
Name:VANBANG, ANTONY NGUYEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONY NGUYEN
Middle Name:
Last Name:VANBANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BANG
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1701 S FEDERAL BLVD # D
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-4898
Mailing Address - Country:US
Mailing Address - Phone:303-936-1760
Mailing Address - Fax:303-934-4036
Practice Address - Street 1:1701 S FEDERAL BLVD # D
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4898
Practice Address - Country:US
Practice Address - Phone:303-936-1760
Practice Address - Fax:303-934-4036
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054747208D00000X
NE13674208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000138028Medicaid
CO9000138028Medicaid