Provider Demographics
NPI:1699859769
Name:NGUYEN, PAUL TUAN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TUAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TUAN
Other - Middle Name:QUOC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 ROTONDA WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-4493
Mailing Address - Country:US
Mailing Address - Phone:928-642-7428
Mailing Address - Fax:928-237-4057
Practice Address - Street 1:117 ROTONDA WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-4493
Practice Address - Country:US
Practice Address - Phone:928-642-7428
Practice Address - Fax:928-237-4057
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ518308Medicaid
AZ518308Medicaid